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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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Baessato F, Romeo C, Rabbat MG, Pontone G, Meierhofer C. A Comprehensive Assessment of Cardiomyopathies through Cardiovascular Magnetic Resonance: Focus on the Pediatric Population. Diagnostics (Basel) 2022; 12:diagnostics12051022. [PMID: 35626178 PMCID: PMC9139185 DOI: 10.3390/diagnostics12051022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/26/2022] Open
Abstract
Cardiomyopathies (CMPs) are a heterogeneous group of diseases that involve the myocardium and result in systolic or diastolic impairment of the cardiac muscle, potentially leading to heart failure, malignant arrhythmias, or sudden cardiac death. Occurrence in pediatric age is rare but has been associated with worse outcomes. Non-invasive cardiac imaging techniques, integrated with clinical, genetic, and electrocardiographic data, have shown a pivotal role in the clinical work-up of such diseases by defining structural alterations and assessing potential complications. Above all modalities, cardiovascular magnetic resonance (CMR) has emerged as a powerful tool complementary to echocardiography to confirm diagnosis, provide prognostic information and guide therapeutic strategies secondary to its high spatial and temporal resolution, lack of ionizing radiation, and good reproducibility. Moreover, CMR can provide in vivo tissue characterization of the myocardial tissue aiding the identification of structural pathologic changes such as replacement or diffuse fibrosis, which are predictors of worse outcomes. Large prospective randomized studies are needed for further validation of CMR in the context of childhood CMPs. This review aims to highlight the role of advanced imaging with CMR in CMPs with particular reference to the dilated, hypertrophic and non-compacted phenotypes, which are more commonly seen in children.
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Affiliation(s)
- Francesca Baessato
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany;
- Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy;
- Correspondence:
| | - Cristina Romeo
- Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy;
| | - Mark G. Rabbat
- Division of Cardiology, Loyola University Medical Center, Chicago, IL 60153, USA;
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany;
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Marterer R, Hongchun Z, Tschauner S, Koestenberger M, Sorantin E. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters. Eur Radiol 2015; 25:3528-35. [DOI: 10.1007/s00330-015-3788-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 11/29/2022]
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Ntsinjana HN, Tann O, Taylor AM. Trends in pediatric cardiovascular magnetic resonance imaging. Acta Radiol 2013; 54:1063-74. [PMID: 23390156 DOI: 10.1177/0284185113475609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging has significantly evolved over the last decade, becoming an integral part of the contemporary assessment of both congenital and acquired pediatric heart disease. Recent trends show that there is a growing interest in clinical applications and research in this field. An attempt to discuss the evolving technologies, techniques, and applications of CMR in pediatrics is not complete without understanding the current strengths of the modality. CMR complements readily available echocardiography, in many cases information from CMR can remove the need for invasive angiographic catheterization, and in other cases can be used to augment cardiac catheterisation.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
| | - Oliver Tann
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL
Institute of Cardiovascular Sciences, London
- Cardiorespiratory Unit, Great Ormond
Street Hospital for Children, London, UK
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Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15:51. [PMID: 23763839 PMCID: PMC3686659 DOI: 10.1186/1532-429x-15-51] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.
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Affiliation(s)
- Sohrab Fratz
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany
| | - Taylor Chung
- Department of Diagnostic Imaging, Children’s Hospital & Research Center Oakland, Oakland, California, USA
| | - Gerald F Greil
- Department of Pediatric Cardiology, Evelina Children’s Hospital/Guy’s and St. Thomas’ Hospital NHS Foundation Trust; Division of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
| | - Margaret M Samyn
- The Herma Heart Center, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, & Great Ormond Street Hospital for Children, London, UK
| | | | - Shi-Joon Yoo
- Department of Diagnostic Imaging and Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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[Isolated left ventricular non-compaction associated with Ebstein's anomaly. Multimodality non-invasive imaging for the assessment of congenital heart disease]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:100-3. [PMID: 23663894 DOI: 10.1016/j.acmx.2013.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/04/2013] [Accepted: 03/07/2013] [Indexed: 11/22/2022] Open
Abstract
To establish the etiology of heart failure in patients with congenital heart disease can be challenging. Multiple concomitant anomalies that can be missed after an initial diagnosis could be seen in these patients. In patients with congenital heart disease, a more accurate evaluation of cardiac morphology and left ventricular systolic function could be evaluated by recent non-invasive cardiac imaging techniques. We present a rare case where multimodal cardiac imaging was useful to establish the final diagnosis of left ventricular non-compaction associated with Ebstein's anomaly.
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Comparison between proximal thoracic vascular measurements obtained by contrast-enhanced magnetic resonance angiography and by transthoracic echocardiography in infants and children with congenital heart disease. Pediatr Cardiol 2013; 34:492-7. [PMID: 22923009 DOI: 10.1007/s00246-012-0480-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 07/31/2012] [Indexed: 10/28/2022]
Abstract
Accurate assessment of the proximal thoracic vasculature in infants and children with congenital heart disease (CHD) is vital for deciding the appropriate surgical or interventional procedure and predicting outcomes. This information usually is obtained by transthoracic echocardiography (TTE). Contrast-enhanced magnetic resonance angiography (CE-MRA) frequently is used to obtain diagnostic data when the image quality by TTE is limited. Calculation of z-scores for measurements obtained by CE-MRA in this population currently is not possible due to the lack of normative data. A reasonable agreement between vessel dimensions by CE-MRA and TTE will allow the use of TTE-based z-scores on measurements from CE-MRA. This study examines the accuracy and agreement of proximal thoracic vascular measurements obtained by CE-MRA versus TTE. Infants and children younger than 3 years with CHD who had a CE-MRA between August 2006 and May 2011 were retrospectively identified. Main and branch pulmonary arteries, ascending aorta, distal transverse arch, and aortic isthmus were measured from CE-MRA and TTE in analogous imaging planes and locations by two investigators blinded to each other. The study enrolled 35 subjects with CHD. The median age was 129 days (range, 0-1077 days), and the median weight was 5.8 kg (range, 2.16-17 kg). The median interval between the two imaging methods was 9 days (range, 0-60 days). Data analysis was performed with 129 of the 210 possible paired measurements. The remaining 81 paired measurements could not be performed due to inaccurate visualization of vessel borders or an unavailable imaging plane from TTE, CE-MRA, or both. The range of vessel sizes measured from 2.8 to 23.4 mm. There was excellent correlation between CE-MRA and TTE (r = 0.94, p < 0.001). The mean difference between the measurements was -0.1 ± 1.2 mm, and the limits of agreement were -2.5 to 2.3 mm. Proximal thoracic vascular measurements obtained by CE-MRA and TTE in infants and children with CHD have a strong correlation. The agreement between these two imaging methods is adequate. Until normative data for vessel size measurements obtained from CE-MRA are available for this population, TTE-based z-scores can be applied to the measurements obtained by CE-MRA.
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Dabir D, Naehle CP, Clauberg R, Gieseke J, Schild HH, Thomas D. High-resolution motion compensated MRA in patients with congenital heart disease using extracellular contrast agent at 3 Tesla. J Cardiovasc Magn Reson 2012; 14:75. [PMID: 23107424 PMCID: PMC3552711 DOI: 10.1186/1532-429x-14-75] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 09/27/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Using first-pass MRA (FP-MRA) spatial resolution is limited by breath-hold duration. In addition, image quality may be hampered by respiratory and cardiac motion artefacts. In order to overcome these limitations an ECG- and navigator-gated high-resolution-MRA sequence (HR-MRA) with slow infusion of extracellular contrast agent was implemented at 3 Tesla for the assessment of congenital heart disease and compared to standard first-pass-MRA (FP-MRA). METHODS 34 patients (median age: 13 years) with congenital heart disease (CHD) were prospectively examined on a 3 Tesla system. The CMR-protocol comprised functional imaging, FP- and HR-MRA, and viability imaging. After the acquisition of the FP-MRA sequence using a single dose of extracellular contrast agent the motion compensated HR-MRA sequence with isotropic resolution was acquired while injecting the second single dose, utilizing the timeframe before viability imaging. Qualitative scores for image quality (two independent reviewers) as well as quantitative measurements of vessel sharpness and relative contrast were compared using the Wilcoxon signed-rank test. Quantitative measurements of vessel diameters were compared using the Bland-Altman test. RESULTS The mean image quality score revealed significantly better image quality of the HR-MRA sequence compared to the FP-MRA sequence in all vessels of interest (ascending aorta (AA), left pulmonary artery (LPA), left superior pulmonary vein (LSPV), coronary sinus (CS), and coronary ostia (CO); all p < 0.0001). In comparison to FP-MRA, HR-MRA revealed significantly better vessel sharpness for all considered vessels (AA, LSPV and LPA; all p < 0.0001). The relative contrast of the HR-MRA sequence was less compared to the FP-MRA sequence (AA: p <0.028, main pulmonary artery: p <0.004, LSPV: p <0.005). Both, the results of the intra- and interobserver measurements of the vessel diameters revealed closer correlation and closer 95 % limits of agreement for the HR-MRA. HR-MRA revealed one additional clinical finding, missed by FP-MRA. CONCLUSIONS An ECG- and navigator-gated HR-MRA-protocol with infusion of extracellular contrast agent at 3 Tesla is feasible. HR-MRA delivers significantly better image quality and vessel sharpness compared to FP-MRA. It may be integrated into a standard CMR-protocol for patients with CHD without the need for additional contrast agent injection and without any additional examination time.
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Affiliation(s)
- Darius Dabir
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Ralf Clauberg
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Hans H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Bonn, Germany
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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Attenhofer Jost CH, Edmister WD, Julsrud PR, Dearani JA, Savas Tepe M, Warnes CA, Scott CG, Anavekar NS, Ammash NM, Connolly HM. Prospective comparison of echocardiography versus cardiac magnetic resonance imaging in patients with Ebstein’s anomaly. Int J Cardiovasc Imaging 2011; 28:1147-59. [DOI: 10.1007/s10554-011-9923-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
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Sreevastava DK, Setlur R. Anaesthesia for Paediatric Cardiac MRI. Med J Armed Forces India 2011; 64:204-7. [PMID: 27408145 DOI: 10.1016/s0377-1237(08)80092-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Accepted: 08/31/2007] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND General anaesthesia (GA) for cardiac magnetic resonance imaging (MRI) in patients with congenital heart disease (CHD) is challenging for the anaesthesiologist. METHODS A retrospective review of anaesthesia for cardiac MRI between January 2002 and December 2005 was undertaken. RESULT 28 children with cardiac disease were subjected to general anaesthesia for cardiac MRI, of which four patients were in ASA Grade I, five in Grade II, seventeen in Grade III and two in Grade IV. Two patients had undergone previous cardiac surgery. All the cases were managed as inpatients, of which 18 had cyanotic cardiac defects (SpO2 between 65 and 85%). On two occasions scans were interrupted because of low oxygen saturation or haemodynamic instability during GA. No patient was admitted to the hospital for complications related to general anaesthesia though all were kept under observation for two hours before being shifted to ward. Five patients had a brief episode of hypotension/desaturation during the MRI and responded quickly to interventions. CONCLUSION General anaesthesia for cardiac MRI can be administered safely in children with CHD.
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Affiliation(s)
- D K Sreevastava
- Classified Specialist (Anaesthesiology & Paed Anaes), Command Hospital (Central Command), Lucknow
| | - R Setlur
- Reader, Dept of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune
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Śpiewak M, Biernacka EK, Małek ŁA, Petryka J, Kowalski M, Miłosz B, Żabicka M, Miśko J, Rużyłło W. Right ventricular outflow tract obstruction as a confounding factor in the assessment of the impact of pulmonary regurgitation on the right ventricular size and function in patients after repair of tetralogy of fallot. J Magn Reson Imaging 2011; 33:1040-6. [DOI: 10.1002/jmri.22532] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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van der Bijl N, Geleijns J, Joemai RMS, Bax JJ, Schuijf JD, de Roos A, Kroft LJM. Recent developments in cardiac CT. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Congenital Heart Disease and Multi-modality Imaging. Heart Lung Circ 2010; 19:133-44. [DOI: 10.1016/j.hlc.2010.01.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 12/09/2009] [Accepted: 01/04/2010] [Indexed: 11/20/2022]
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Naehle CP, Müller A, Willinek WA, Meyer C, Hestermann T, Gieseke J, Schild H, Thomas D. First-pass and steady-state magnetic resonance angiography of the thoracic vasculature using gadofosveset trisodium. J Magn Reson Imaging 2009; 30:809-16. [DOI: 10.1002/jmri.21919] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ge RL, Ru-yan M, Hai-hua B, Xi-peng Z, Hai-ning Q. Changes of Cardiac Structure and Function in Pediatric Patients with High Altitude Pulmonary Hypertension in Tibet. High Alt Med Biol 2009; 10:247-52. [PMID: 19775214 DOI: 10.1089/ham.2009.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, P.R. China
| | - Ma Ru-yan
- Department of Cardiology, Qinghai Provincial Women's and Children's Hospital, Xining, Qinghai, P.R. China
| | - Bao Hai-hua
- Department of MRI, Affiliated Hospital of Qinghai University, Xining, 810000, Qinghai, P.R. China
| | - Zhao Xi-peng
- Department of MRI, Affiliated Hospital of Qinghai University, Xining, 810000, Qinghai, P.R. China
| | - Qi Hai-ning
- Department of Cardiology, Qinghai Provincial Women's and Children's Hospital, Xining, Qinghai, P.R. China
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Koskenvuo JW, Järvinen V, Pärkkä JP, Kiviniemi TO, Hartiala JJ. Cardiac magnetic resonance imaging in valvular heart disease. Clin Physiol Funct Imaging 2009; 29:229-40. [DOI: 10.1111/j.1475-097x.2009.00865.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Fratz S, Hess J, Schuhbaeck A, Buchner C, Hendrich E, Martinoff S, Stern H. Routine clinical cardiovascular magnetic resonance in paediatric and adult congenital heart disease: patients, protocols, questions asked and contributions made. J Cardiovasc Magn Reson 2008; 10:46. [PMID: 18928522 PMCID: PMC2579426 DOI: 10.1186/1532-429x-10-46] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 10/17/2008] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) of patients with congenital heart disease (CHD) has become routine clinical practice. However, existing CMR protocols focus predominantly on patients with ischemic heart disease, and information is limited on the types of patient with CHD who benefit from CMR investigation, and in what ways. Therefore the aim of this study was to answer the questions: What type of patients were studied by CMR in a centre specializing in paediatric and adult CHD management? What questions were asked, which protocols were used and were the questions successfully answered? To answer these questions, we conducted a cohort study of all 362 patients that received routine clinical CMR during 2007 at the Department of Paediatric Cardiology and Congenital Heart Disease at the Deutsches Herzzentrum München. RESULTS Underlying diagnosis was in 33% Fallot's tetralogy, 17% aortic coarctation, 8% Ebstein's disease, 6% Marfan's disease, 4% single ventricle with Fontan-like circulation, and 32% others. Median age was 26 years (7 days - 75 years). Ventricular volumes were assessed in 67% of the patients; flow in 74%; unknown anatomy only in 9%; specific individual morphology of known anatomy in 83%; myocardial fibrosis in 8%; stress-induced myocardial perfusion defects in 1%. Only in 3% of the cases the question could not be fully answered. CONCLUSION Contrary to common belief, routine CMR of patients with CHD was not requested to address global anatomical questions so much as to clarify specific questions of morphology and function of known anatomy. The CMR protocols used differed markedly from those widely used in patients with ischemic heart disease.
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Affiliation(s)
- Sohrab Fratz
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - John Hess
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Annika Schuhbaeck
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Christine Buchner
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Eva Hendrich
- Department of Radiology, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Stefan Martinoff
- Department of Radiology, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Heiko Stern
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
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Comparison of the cardiovascular effects of isoflurane and sevoflurane as measured by magnetic resonance imaging in children with congenital heart disease. J Clin Anesth 2008; 20:40-4. [PMID: 18346608 DOI: 10.1016/j.jclinane.2007.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 07/17/2007] [Accepted: 08/10/2007] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To compare the cardiovascular effects of isoflurane and sevoflurane at minimum alveolar concentration (MAC) = 1 in children with congenital heart disease using cardiac magnetic resonance imaging. DESIGN Randomized, crossover, single-blinded study. SETTING Tertiary-care teaching hospital. PATIENTS 10 pediatric patients with congenital heart diseases scheduled to undergo cardiac magnetic resonance studies. INTERVENTIONS Patients were randomized to receive either isoflurane or sevoflurane as the "first inhalation agent." After a period or more than 20 minutes, they were crossed over to receive the "second inhalation agent." MEASUREMENTS Heart rate, mean arterial pressure (MAP), cardiac index, stroke volume index, and ejection fraction (EF) at one MAC for both agents were all recorded. MAIN RESULTS Both isoflurane and sevoflurane caused a significant decrease in MAP from the baseline (P = 0.013). The mean values (+/-SD) of stroke volume (mL), cardiac index (L min(-1) m(-2)), and EF (%) for isoflurane versus sevoflurane were 21.5 (+/-9.2) versus 19.6 (+/-6.2), 4.1 (+/-1.2) versus 3.7 (+/-0.87), and 64.2 (+/-14.5) versus 62.5 (+/-13.8), respectively. CONCLUSION Both isoflurane and sevoflurane were found to be comparable in terms of cardiovascular effects.
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Bastarrika Alemañ G, Gavira Gómez J, Zudaire Díaz-Tejeiro B, Castaño Rodríguez S, Romero Ibarra C, Sáenz De Buruaga J. Resonancia magnética cardíaca de las cardiopatías congénitas en el adulto. RADIOLOGIA 2007; 49:397-405. [DOI: 10.1016/s0033-8338(07)73810-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wang XM, Wu LB, Sun C, Liu C, Chao BT, Han B, Zhang YT, Chen HS, Li ZJ. Clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. Eur J Radiol 2007; 64:296-301. [PMID: 17399932 DOI: 10.1016/j.ejrad.2007.02.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 02/16/2007] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the clinical application of 64-slice spiral CT in the diagnosis of the Tetralogy of Fallot. METHODS Eighteen patients with diagnosed Tetralogy of Fallot underwent cardiac CT angiography with 64-slice CT (CTA). Two- and three-dimensional images were used for diagnosing in all cases by means of MPR (coronal, sagital and oblique), cMPR, MIP and VRT. RESULTS All patients had ventricular septal defect, pulmonary stenosis and hypertrophy of right ventricle. The morphologic features of Tetralogy of Fallot were equal to echocardiography. Patent ductus arteriosus (PDA) were detected on eight patients. Main coronary artery branches and partial sub-branches were visualized in all patients. Abnormal coronary arteries were found in seven cases: both left and right main coronary artery arising from the right aortic sinus one case, right main coronary artery and circumflex (CX) arising from the right aortic sinus one case, left anterior descending (LAD) and CX arising from left aortic sinus directly one case, left and right coronary artery arising from back and front of the aortic sinus, respectively, three cases. Pulmonary artery branch stenosis was found in 12 cases and branch pulmonary artery dilation noticed in 1 case. Double superior vena cava was also found in one case. According to the surgery the diagnostic accuracy of CT and Echocardiography was 95.45 and 83.33%, respectively. CONCLUSION Two- and three-dimensional 64-slice CTA not only show the overall anatomical structure of the heart, but also show coronary and pulmonary arteries. With these results, evaluation of coronary anomalies and pulmonary artery stenosis with 64-MSCT is extremely valuable for planning the operative procedure on the patients with Tetralogy of Fallot.
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Affiliation(s)
- Xi-Ming Wang
- Tianjin Medical University, Tianjin City, PR China.
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23
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Cabrera Duro A, Galdeano Miranda JM, Cabrera-Zubizarreta A, Pastor Menchaca E, Rodrigo Carbonero D, Alcibar Villa J, García ML, Sáez Garmendía F, Aramendi Gallardo JI. [Magnetic resonance imaging in long-term assessment after surgery for aortic coarctation]. An Pediatr (Barc) 2007; 67:319-28. [PMID: 17949641 DOI: 10.1016/s1695-4033(07)70649-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Spin echo or gradient echo magnetic resonance imaging provides enough information to plan patient management and can be completed with the use of three-dimensional magnetic resonance angiography to evaluate the need for reintervention, assess follow-up, or discharge the patient. PATIENTS AND METHODS From 1990-2003, we evaluated 101 patients after initial corrective surgery for aortic coarctation at the age of 3.1 +/- 3 years, with subsequent postoperative assessment at 1 year and again 12.4 +/- 4.2 years later. No mortality was registered during the follow-up. Corrective surgery was performed in 32 patients (31.6 %) before the first month of life. All the patients were evaluated with spin-echo and echo gradient and 34 were evaluated with magnetic resonance angiography. The patients were classified into two groups: group A consisted of 68 patients (11 < 1 month old) with no complications. End-to-end anastomosis was performed in 55, the Alvarez technique in five, the Waldhausen technique in six, and conduit in two. Group B consisted of 33 patients complicated with early aortic recoarctation (21 corrected before the age of 1 month). End-to-end anastomosis was performed in 29, the Alvarez technique in two, and grafting in two. During the follow-up, 43 reinterventions were performed. Isthmus diameter/descending aorta diameter at the diaphragmatic level and repaired site diameter/descending aorta diameter at the diaphragmatic level were measured. RESULTS Group A: the isthmus diameter/descending aorta diameter at the diaphragmatic level index was 0.92 +/- 0.08 and the repaired site diameter/ descending aorta diameter at diaphragmatic level index was 0.90 +/- 0.05. Twenty-three patients were assessed by means of three-dimensional magnetic resonance angiography, which revealed two late stenosis (one in a 10-year-old patient with an end-to-end anastomosis performed previously, and another in an 18-year-old patient with a proximal and distal obstructed conduit). Group B: the isthmus diameter/descending aorta diameter index was 0.84 +/- 0.1 and the repaired site diameter/ descending aorta diameter index was 0.82 +/- 0.11. Eleven patients were assessed by means of three-dimensional magnetic resonance angiography, which revealed five stenosis indexes (0.53-0.73) surgically corrected before the age of 2 months, four with an initial technique based on end-to-end anastomosis and one with a graft. CONCLUSIONS Our results support the influence of young age, the use of end-to-end anastomosis and grafts in recoarctation and their late influence on recurrent recoarctation. The patients in group A were discharged in childhood or adulthood after periodic follow-up every 5 years with magnetic resonance angiography for 18 years with results within the normal range, while patients in group B required longer follow-up.
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Affiliation(s)
- A Cabrera Duro
- Servicio de Cardiología Pediátrica, Hospital de Cruces, Baracaldo, España.
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24
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Lovato L, Giardini A, La Palombara C, Russo V, Gostoli V, Gargiulo G, Picchio FM, Fattori R. Role and effectiveness of cardiovascular magnetic resonance in the diagnosis, preoperative evaluation and follow-up of patients with congenital heart diseases. Radiol Med 2007; 112:660-80. [PMID: 17673954 DOI: 10.1007/s11547-007-0171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 11/20/2006] [Indexed: 10/23/2022]
Abstract
The substantial advances in the medical and surgical treatment of congenital heart diseases have dramatically improved patients' life expectancy, as well as increased the number of those needing lifelong monitoring to identify complications and residual defects. Magnetic resonance imaging (MRI) is an ideal imaging modality for the follow-up of these young patients owing to its noninvasiveness, high reproducibility and morphological and functional accuracy. This paper describes the most appropriate MRI techniques and sequences for the study of cardiovascular heart diseases on the basis of an analysis of MRI studies carried out between January 2003 and June 2006 on 274 patients affected by all of the main congenital cardiovascular malformations, as well as a review of the literature. The advantages of MRI with respect to other imaging techniques, the problems encountered and the main clinical applications and indications of MRI, with special reference to the most common disease entities, are then discussed to define the role, the utility and the future perspectives of this imaging technique in the study of congenital heart diseases.
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Affiliation(s)
- L Lovato
- US di Radiologia Cardiovascolare, Università di Bologna, Bologna, Italy.
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Foran AM, Fitzpatrick JA, Allsop J, Schmitz S, Franklin J, Pamboucas C, O'Regan D, Hajnal JV, Edwards AD. Three-tesla cardiac magnetic resonance imaging for preterm infants. Pediatrics 2007; 120:78-83. [PMID: 17606564 DOI: 10.1542/peds.2006-3305] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We aimed to establish the feasibility of acquiring 3.0-T cardiac MRIs without sedation, anesthesia, or breath-holding for preterm infants and to obtain preliminary quantitative data on left ventricular function in this population. METHODS Twelve preterm infants underwent 3.0-T cardiac MRI without sedation or breath-holding. The median gestational age was 29 weeks (range: 26-33 weeks), the median birth weight was 1240 g (range: 808-2200 g), and the median postconceptional age at the time of cardiac MRI was 33 weeks (range: 31-40 weeks). Anatomic images were acquired with T2-weighted spin-echo sequences, and ventricular function was assessed with balanced steady-state free precession cine sequences. We assessed left ventricular function by using the area-length ejection fraction method on horizontal long-axis images and the volumetric Sergeant's discs method of analysis on short-axis images. RESULTS Imaging was successful for 10 of 12 infants. For those 10, the area-length ejection fraction method in the horizontal long-axis plane estimated median stroke volume at 2.9 mL, cardiac output at 0.4 L/minute, end-diastolic volume at 3.8 mL, end-systolic volume at 0.3 mL, and ejection fraction at 74.6%. Short-axis volumetric estimations were made for 4 infants. With this approach, the median stroke volume was 2.4 mL, cardiac output 0.35 L/minute, end-diastolic volume 4.3 mL, end-systolic volume 2.1 mL, and ejection fraction 56%. CONCLUSIONS Three-tesla cardiac MRI is feasible for preterm infants without sedation, anesthesia, or breath-holding and has the potential to provide a wide range of precise quantitative data that may be of great value for the investigation of cardiac function in preterm infants.
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Affiliation(s)
- Adrienne M Foran
- Department of Paediatrics, Imperial College London, London W12 OHS, England
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26
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Abstract
The most common imaging modality used for diagnosis of aortic disease is CT, followed by transesophageal echocardiography, MRI, and aortography. If multiple imaging is performed, the initial imaging technique most frequently employed is computerized tomography. During the past decade, computed tomographic angiography (CTA) has become a standard non-invasive imaging modality for the depiction of vascular anatomy and pathology. The quality and speed of CTA examinations have increased dramatically as CT technology has evolved from-channel spiral CT systems to multichannel (4-, 8-, 10- and 16-slice) spiral CT system. The quality and speed of CTA is superior to other imaging modalities, and it is also cheaper and less invasive. CTA of the aorta has proven to be superior in diagnostic accuracy to conventional arteriography in several applications.
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Affiliation(s)
- Tongfu Yu
- Radiological Department of the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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27
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Fitoz S, Unsal N, Tekin M, Tutar E. Contrast-enhanced MR angiography of thoracic vascular malformations in children. Int J Cardiol 2007; 123:3-11. [PMID: 17395307 DOI: 10.1016/j.ijcard.2006.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 11/27/2006] [Accepted: 12/30/2006] [Indexed: 11/27/2022]
Abstract
To plan an effective management of thoracic vascular malformations, clinicians must have a clear understanding of the anatomy. Although echocardiography and angiography are the leading imaging modalities in patients with congenital cardiovascular anomalies, magnetic resonance (MR) imaging and computed tomography (CT) are valuable noninvasive adjuncts. MR imaging and CT are effective in demonstrating the complex extracardiac morphology and yield helpful information that can change the treatment plan. Although recent reports state the usefulness of multidetector CT (MDCT), in terms of pediatric population, the significance of radiation exposure should be taken into account. Thus, contrast enhanced MR angiography, as a guide in planning surgery, seems to be the best alternative to conventional angiography in the diagnosis of congenital vascular malformations. In this review, the diagnostic features of thoracic vascular malformations in pediatric population are discussed, and, the potential uses of contrast-enhanced MR angiography are emphasized with the retrospective evaluation of imaging findings in 114 examinations.
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Affiliation(s)
- Suat Fitoz
- Ankara University, School of Medicine, Department of Radiology, Ibn-i Sina Hospital, 06100 Sihhiye, Ankara, Turkey.
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de la Pena E, Nguyen PK, Nayak KS, Yang PC, Rosenthal DN, Hu BS, Pauly JM, McConnell MV. Real-time color-flow CMR in adults with congenital heart disease. J Cardiovasc Magn Reson 2007; 8:809-15. [PMID: 17060103 PMCID: PMC4634869 DOI: 10.1080/10976640600777728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
CMR is valuable in the evaluation of congenital heart disease (CHD). Traditional flow imaging sequences involve cardiac and respiratory gating, increasing scan time and susceptibility to arrhythmias. We studied a real-time color-flow CMR system for the detection of flow abnormalities in 13 adults with CHD. All 16 congenital flow abnormalities previously detected by echocardiography were visualized using color-flow CMR, including atrial septal defects (n = 4), ventricular septal defects (n = 9), aortic coarctation (n = 1), Blalock-Taussig shunt (n = 1) and Fontan shunt (n = 1). Real-time color-flow CMR can identify intra- and extra-cardiac flow abnormalities in adults with congenital heart disease.
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Affiliation(s)
- Erasmo de la Pena
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Patricia K. Nguyen
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Krishna S. Nayak
- Department of Electrical Engineering, University of Southern California, Los Angeles, California, USA
| | - Phillip C. Yang
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David N. Rosenthal
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Bob S. Hu
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - John M. Pauly
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Michael V. McConnell
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
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Fenchel M, Greil GF, Martirosian P, Kramer U, Schick F, Claussen CD, Sieverding L, Miller S. Three-dimensional morphological magnetic resonance imaging in infants and children with congenital heart disease. Pediatr Radiol 2006; 36:1265-72. [PMID: 17006655 DOI: 10.1007/s00247-006-0314-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 07/30/2006] [Accepted: 08/07/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cardiac MRI has become a clinically useful supplement to ECHO and conventional X-ray angiography in the diagnostic work-up of patients with congenital heart disease (CHD). Three-dimensional (3D) sequences are capable of depicting both intracardiac and extracardiac structures with high accuracy in adults and adolescents. However, diagnostic image quality in infants and young children has not yet been reported. OBJECTIVE To apply an optimized 3D steady-state free-precession (SSFP) MR sequence in infants and children with CHD. MATERIALS AND METHODS In 20 patients (median age 1.8 years; ten male) with CHD, whole-chest imaging was performed with navigator-gated, isotropic 3D SSFP MRI at 1.5 T. Sequence parameters were adapted to special requirements in infancy. Measurements of intra- and extracardiac structures were performed by two independent observers and compared to spin-echo and cine gradient-recalled-echo sequences. RESULTS Diagnostic image quality was achieved with the 3D SSFP technique in all patients, allowing the establishment of a diagnosis in all cases. Interobserver comparison of measurements from reformatted 3D SSFP datasets revealed only minor differences with standard deviations ranging from 0.3-1.3 mm for intracardiac and 0.3-0.7 mm for extracardiac anatomy (P = ns). CONCLUSION Isotropic 3D SSFP MRI allows reliable and accurate assessment of CHD, even in free-breathing infants and young children.
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Affiliation(s)
- Michael Fenchel
- Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, Tuebingen, 72076, Germany.
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30
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De Castro S, Caselli S, Papetti F, Ventriglia F, Giardina A, Cavarretta E, Di Angelantonio E, Marcantonio A, Igual Perez FD, Pandian NG, Marino B, Fedele F. Feasibility and clinical impact of live three-dimensional echocardiography in the management of congenital heart disease. Echocardiography 2006; 23:553-61. [PMID: 16911328 DOI: 10.1111/j.1540-8175.2006.00262.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Precise assessment of congenital heart lesions requires inferential evaluation from multiple two-dimensional echocardiographic images (2DE). The aim of our study was to assess the usefulness of transthoracic live three-dimensional echocardiography (3DE) in the evaluation of congenital heart disease. METHODS Eighty-two patients (from 4 months to 31 years, mean age 12 +/- 7.5, 38 males and 44 females), known to have congenital heart lesions, prospectively underwent both 2DE and 3DE. Conventional data acquisition by 2DE and "full volume" 3DE acquisition (apical four chambers, parasternal long and short axes, subcostal windows) were carried out by two independent and blinded operators. Data derived from 3DE were compared to 2DE, and 3DE results were graded into three categories: (A) new findings not seen on 2D echo studies, but not critical to therapeutic decision making; (B) additional anatomic information useful in therapeutic decision making; and (C) information equivalent to 2D echo studies. RESULTS Two out of 82 patients (2%) were excluded because of suboptimal 3DE images. In comparison with 2DE studies, 3DE was graded A in 23 patients (29%), B in 28 patients (35%), and C in 29 patients (36%). In the patients with group B results, atrial and ventricular septal defects, endocardial cushion defects, and l-transposition of great vessels were the most represented pathologies in which 3DE aided medical or surgical therapeutic options. While the new findings in group A did not influence therapy, they defined the whole spectrum of abnormalities in those patients. In patients who fell under group C results, 3DE provided a direct realistic display of the pathology detected by 2DE. CONCLUSIONS Our study demonstrates that live 3DE, easily performed at the bedside, provides incremental information on patients with a variety of congenital heart lesions. In the clinical scenario, it clarifies the pathology in all its dimensions, particularly in complex lesions with the incremental information having impact on therapeutic decision making.
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Affiliation(s)
- Stefano De Castro
- Department of Cardiovascular and Respiratory Sciences, "La Sapienza" University of Rome, Rome, Italy.
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Gentchos GE, Tischler MD, Christian TF. Imaging and quantifying valvular heart disease using magnetic resonance techniques. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2006; 8:453-60. [PMID: 17078909 DOI: 10.1007/s11936-006-0033-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Echocardiography remains the cornerstone of noninvasive valvular heart disease evaluation. There are instances where MRI can be of use. Aside from the obvious advantage where limited acoustic windows are present, cardiac magnetic resonance (CMR) allows for imaging in any desired plane, and advantage can be taken of the ability to align with any regurgitant or stenotic flow jet. The high spatial resolution and contrast allow for accurate detail of valvular anatomy, but it must be remembered that the images represent a composite of eight to 12 heart cycles. For visualizing multiple valvular abnormalities simultaneously, cardiac MRI has a distinct advantage. Finally, a CMR valvular examination can be combined with accurate assessments of left and right ventricular function, myocardial stress perfusion imaging, and detailed viability determinations in a single examination. This provides a comprehensive presurgical evaluation of cardiac physiology.
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Affiliation(s)
- George E Gentchos
- Departments of Medicine and Radiology, Baird 191, MCHV, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
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Didier D, Saint-Martin C, Lapierre C, Trindade PT, Lahlaidi N, Vallee JP, Kalangos A, Friedli B, Beghetti M. Coarctation of the aorta: pre and postoperative evaluation with MRI and MR angiography; correlation with echocardiography and surgery. Int J Cardiovasc Imaging 2005; 22:457-75. [PMID: 16267620 DOI: 10.1007/s10554-005-9037-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Accepted: 09/08/2005] [Indexed: 10/25/2022]
Abstract
AIMS To compare MRI and MRA with Doppler-echocardiography (DE) in native and postoperative aortic coarctation, define the best MR protocol for its evaluation, compare MR with surgical findings in native coarctation. MATERIALS AND METHODS 136 MR studies were performed in 121 patients divided in two groups: Group I, 55 preoperative; group II, 81 postoperative. In group I, all had DE and surgery was performed in 35 cases. In group II, DE was available for comparison in 71 cases. MR study comprised: spin-echo, cine, velocity-encoded cine (VEC) sequences and 3D contrast-enhanced MRA. RESULTS In group I, diagnosis of coarctation was made by DE in 33 cases and suspicion of coarctation and/or aortic arch hypoplasia in 18 cases. Aortic arch was not well demonstrated in 3 cases and DE missed one case. There was a close correlation between VEC MRI and Doppler gradient estimates across the coarctation, between MRI aortic arch diameters and surgery but a poor correlation in isthmic measurements. In group II, DE detected a normal isthmic region in 31 out of 35 cases. Postoperative anomalies (recoarctation, aortic arch hypoplasia, kinking, pseudoaneurysm) were not demonstrated with DE in 50% of cases. CONCLUSIONS MRI is superior to DE for pre and post-treatment evaluation of aortic coarctation. An optimal MR protocol is proposed. Internal measurement of the narrowing does not correspond to the external aspect of the surgical narrowing.
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Affiliation(s)
- D Didier
- Department of Radiology, University Hospital of Geneva, Geneva, Switzerland.
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Boechat MI, Ratib O, Williams PL, Gomes AS, Child JS, Allada V. Cardiac MR Imaging and MR Angiography for Assessment of Complex Tetralogy of Fallot and Pulmonary Atresia. Radiographics 2005; 25:1535-46. [PMID: 16284133 DOI: 10.1148/rg.256045052] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breath-hold electrocardiographically gated cardiac magnetic resonance (MR) imaging and contrast material-enhanced MR angiography are emerging as ideal techniques for the evaluation of complex congenital heart disease. Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease and, in its classic form, is associated with varying degrees of hypoplasia of the central and peripheral pulmonary arteries, with valvar pulmonary atresia and collateral aortopulmonary vessels occupying the extreme end of the spectrum. Accurate assessment of the size and anatomy of the pulmonary arteries is often difficult with echocardiography and conventional cineangiography. Compared with echocardiography in particular, cardiac MR imaging with three-dimensional reconstruction has distinct advantages for pre- or postoperative assessment of pulmonary anatomy in patients with tetralogy of Fallot and pulmonary atresia. MR imaging enables the clear and complete depiction of anatomy and thus can provide additional information about pulmonary artery abnormalities that are difficult to evaluate with conventional cardiac imaging techniques.
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Affiliation(s)
- M Ines Boechat
- Department of Radiological Sciences, University of California, David Geffen School of Medicine, Box 951721, Los Angeles, CA 90095-1721, USA.
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Samyn MM. A review of the complementary information available with cardiac magnetic resonance imaging and multi-slice computed tomography (CT) during the study of congenital heart disease. Int J Cardiovasc Imaging 2005; 20:569-78. [PMID: 15856644 DOI: 10.1007/s10554-004-7021-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The incidence of congenital heart disease is approximately 4-6 per 1000 new births; however, the number of people living with congenital heart disease (CHD) is increasing, because of improved diagnosis, medical, and surgical management. While echocardiography continues to be the mainstay of non-invasive imaging, cardiac MRI (cMRI) and computed tomography (CT) have taken on increasing roles in the diagnosis of congenital heart disease in infants, children, and importantly, adults who may have limited echocardiographic windows, especially if post-operative. Cardiac MRI and multi-slice CT can complement the diagnostic information obtained by echocardiography and invasive cardiac catheterization. Post-operative imaging of CHD is especially enhanced by the spin echo MRI techniques, while gradient cine echo MRI imaging allows functional information that is not encumbered by geometric assumptions. Phase contrast (velocity encoding) cardiac MRI data can provide information about flow, allowing accurate determination of regurgitation and shunt volume. Gadolinium enhanced cMRI or three-dimensional reconstructed images from multi-slice CT angiography allow excellent delineation of vascular structures in complex heart disease. Coronary imaging, while possible with both modalities, appears more facile with fast CT imaging. This article reviews the literature to provide an assessment of the special techniques and considerations needed during the conduct of cardiac MRI/MRA and multi-slice CT examinations during the diagnosis of congenital heart disease in pediatric and adult patients.
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Affiliation(s)
- Margaret M Samyn
- Pediatric Cardiology/Radiology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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Lembcke A, Koch C, Dohmen PM, Rutsch W, Abbara S, Krug LD, Muehler MR, Rogalla P. Electrocardiographic-Gated Multislice Computed Tomography for Visualization of Cardiac Morphology in Congenitally Corrected Transposition of the Great Arteries. J Comput Assist Tomogr 2005; 29:234-7. [PMID: 15772544 DOI: 10.1097/01.rct.0000156198.02741.c0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of congenitally corrected transposition of the great arteries in a 64-old-woman is presented. Diagnosis was missed by invasive angiocardiography. Electrocardiographic-gated multislice computed tomography not only demonstrated switching of the aortic root and pulmonary trunk but clearly identified fine morphologic details of the cardiac chambers, including the atypical coronary artery pattern.
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Affiliation(s)
- Alexander Lembcke
- Department of Radiology, Charité-University of Medicine, Berlin Medical School of the Free University and Humboldt University, Berlin, Germany.
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Tsai-Goodman B, Geva T, Odegard KC, Sena LM, Powell AJ. Clinical role, accuracy, and technical aspects of cardiovascular magnetic resonance imaging in infants. Am J Cardiol 2004; 94:69-74. [PMID: 15219512 DOI: 10.1016/j.amjcard.2004.03.033] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Revised: 03/12/2004] [Accepted: 03/12/2004] [Indexed: 11/17/2022]
Abstract
Cardiovascular magnetic resonance imaging (CMRI) has been shown to be an important alternative to echocardiography and catheterization for diagnostic imaging in older patients with congenital heart disease. However, little information is available on its clinical role, accuracy, and technical aspects in infants. We retrospectively identified all patients <1 year of age who underwent a CMRI examination at our institution over a 4-year period (from 1999 to 2002) and reviewed their medical records. Ninety-nine CMRI examinations were performed in 91 patients (median weight 4.9 kg; range 1.2 to 16.3) at a median age of 102 days (range 1 to 358). Technical modifications were used to improve signal-to-noise ratio and temporal resolution, and specialized personnel and equipment were employed. All CMRI studies were performed under general anesthesia without any complications, and all outpatients (n = 44) were discharged the same day. The primary referral questions for CMRI were delineation of the thoracic vasculature (n = 54), assessment of possible airway compression (n = 25), evaluation of cardiac tumor (n = 6), and other (n = 14). For the thoracic vasculature group, findings at surgery (n = 37) and catheterization (n = 16) were concordant with the CMRI diagnoses. In the airway compression group, findings at surgery (n = 16) were also in agreement with CMRI findings. Tumor types by CMRI in the 3 patients with preoperative studies were confirmed by histologic results. Thus, CMRI has a limited but important diagnostic role in infants with cardiovascular disease. It is an accurate and safe method to delineate the thoracic vasculature, evaluate possible airway compression, and characterize cardiac tumors. CMRI may obviate cardiac catheterization and bronchoscopy in selected cases.
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Affiliation(s)
- Beverly Tsai-Goodman
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Massachusetts 02115, USA
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Affiliation(s)
- Joris P A Beerepoot
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Boulevard, St Louis, MO 63110, USA
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Odegard KC, DiNardo JA, Tsai-Goodman B, Powell AJ, Geva T, Laussen PC. Anaesthesia considerations for cardiac MRI in infants and small children. Paediatr Anaesth 2004; 14:471-6. [PMID: 15153209 DOI: 10.1111/j.1460-9592.2004.01221.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND General anaesthesia is frequently necessary in infants and small children undergoing cardiac magnetic resonance imaging (MRI), because of the imaging techniques, MRI environment and potential need for breath-holding to facilitate imaging. Anaesthetizing paediatric patients with congenital heart disease (CHD) for cardiac MRI poses many challenges for the anaesthetist and this report reviews our experience. METHODS We retrospectively reviewed the anaesthesia and MRI records of all patients who had undergone cardiac MRI between January 2000 and October 2002. RESULTS A total of 250 children with cardiac disease underwent general anaesthesia for cardiac MRI. ASA classification included class I, 2%; class II; 26%; class III, 60% and class IV, 12%. A total of 168 patients (67%) had undergone previous cardiac surgery, 182 patients (94%) were discharged the same day and 48 patients (19.2%) had cyanotic cardiac defects (SpO2 between 55 and 85%). No scans were interrupted because of low oxygen saturation during breath-hold or haemodynamic instability. No patient was admitted to the hospital from complications related to general anaesthesia, but one inhouse patient from the cardiology ward was admitted to the cardiac intensive care unit (CICU) after the MRI because of cyanosis and low cardiac output. Seven patients from the CICU were on inotropic infusions when they underwent the MRI procedure and two others needed inotropic support after induction of anaesthesia. Five patients had a brief episode of hypotension during the MRI and responded quickly to interventions. CONCLUSION Our experience demonstrates that general anaesthesia for cardiac MRI can be provided safely in infants and small children with CHD, despite the complexity and pathophysiology of many defects, the frequent breath-holding for image acquisitions and the MRI environment.
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Affiliation(s)
- Kirsten C Odegard
- Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Goo HW, Park IS, Ko JK, Kim YH, Seo DM, Yun TJ, Park JJ, Yoon CH. CT of congenital heart disease: normal anatomy and typical pathologic conditions. Radiographics 2003; 23 Spec No:S147-65. [PMID: 14557509 DOI: 10.1148/rg.23si035501] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Computed tomography (CT) plays an important supplementary role in the evaluation of patients with congenital heart disease (CHD). Fast multisection spiral CT can be used to obtain isotropic volume data, and high-quality two- and three-dimensional multiplanar reformatted images can be created to accurately and systematically delineate the normal and pathologic morphologic features of the cardiovascular system. CT may be technically challenging and demanding in uncooperative young children. However, it can be used to systematically evaluate the aorta, pulmonary artery, pulmonary vein, cardiac chambers and ventriculoarterial connection, relationship between the upper lobe bronchi and pulmonary arteries, coronary artery, valves, systemic veins (superior vena cava, inferior vena cava, hepatic veins), and visceral situs with a step-by-step approach. This approach may be helpful in understanding the anatomy of the cardiovascular system in CHD patients. CT has both advantages and disadvantages in evaluating patients with CHD. Nevertheless, it is useful in this setting, and radiologists who perform CT in young children with CHD should be familiar with the advantages and disadvantages of CT and with the normal anatomy and typical pathologic conditions in affected patients.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2 dong, Songpa-gu, 138-736 Seoul, Korea.
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Morgan-Hughes GJ, Marshall AJ, Roobottom C. Morphologic assessment of patent ductus arteriosus in adults using retrospectively ECG-gated multidetector CT. AJR Am J Roentgenol 2003; 181:749-54. [PMID: 12933475 DOI: 10.2214/ajr.181.3.1810749] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Noninvasive imaging of a persistently patent ductus arteriosus in adults remains a challenge. Bearing in mind the excellent spatial resolution provided by multidetector CT (MDCT), we postulated that MDCT might be used to evaluate this anatomic defect. We sought to show that MDCT can depict in detail patent ductus arteriosus in adults and allow determination of the size of the duct, degree of calcification, and morphologic classification. CONCLUSION MDCT represents a novel method of noninvasively assessing patent ductus arteriosus in adults that provides detailed anatomic information. Comparison with invasive angiographic findings is needed to validate the technique of sizing of ducts using MDCT.
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Affiliation(s)
- Gareth J Morgan-Hughes
- Department of Cardiology, South West Cardiothoracic Centre, Plymouth National Health Service Trust, Derriford, Plymouth PL6 8DH, United Kingdom
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Shiraishi I, Yamamoto Y, Ozawa S, Kawakita A, Toiyama K, Tanaka T, Sakata K, Hayano T, Itoi T, Yamagishi M, Hamaoka K. Application of helical computed tomographic angiography with differential color imaging three-dimensional reconstruction in the diagnosis of complicated congenital heart diseases. J Thorac Cardiovasc Surg 2003; 125:36-9. [PMID: 12538981 DOI: 10.1067/mtc.2003.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Isao Shiraishi
- Division of Pediatrics, Division of Pediatric Cardiovascular Surgery, Children Research Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Steiner RM, Reddy GP, Flicker S. Congenital cardiovascular disease in the adult patient: imaging update. J Thorac Imaging 2002; 17:1-17. [PMID: 11828207 DOI: 10.1097/00005382-200201000-00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert M Steiner
- Department of Radiology, the Weill Medical College of Cornell University, New York, NY.
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Pearlman JD, Gertz ZM, Wu Y, Simons M, Post MJ. Serial motion assessment by reference tracking (SMART): application to detection of local functional impact of chronic myocardial ischemia. J Comput Assist Tomogr 2001; 25:558-62. [PMID: 11473185 DOI: 10.1097/00004728-200107000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare measurements of wall motion and thickening with and without correcting for cardiac twisting and shortening. METHOD Inversion recovery Gd-DPTA perfusion and cine motion MRI were performed on 12 pigs with chronic ischemia induced by ameroid occluder. Analyses were based on conventional fixed plane imaging and serial motion assessment by reference tracking (SMART). RESULTS Normal motion was 31.3 +/- 1.9%, and normal wall thickening was 41.4 +/- 2.2%. At the maximum perfusion defect, SMART wall motion was 10.5 +/- 2.4% and fixed wall motion was 20.6 +/- 1.7% (p < 0.004), SMART wall thickening was 20.1 +/- 4.4%, and fixed wall thickening was 32 +/- 1.9% (p < 0.03). CONCLUSION SMART measurements of wall thickening and motion detect much smaller thickening and motion in ischemic myocardium than fixed radial metrics. SMART data, covering the entire heart, should prove twice as sensitive to abnormalities in motion and thickening, such as any produced by ischemic heart disease or improved by treatment.
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Affiliation(s)
- J D Pearlman
- Angiogenesis Research Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Reeder SB, Faranesh AZ. Ultrafast pulse sequence techniques for cardiac magnetic resonance imaging. Top Magn Reson Imaging 2000; 11:312-30. [PMID: 11153700 DOI: 10.1097/00002142-200012000-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Cardiac magnetic resonance imaging is a rapidly emerging field that has seen tremendous advances in the past decade. Central to the development of effective imaging strategies has been the advent of high-performance gradient hardware and the exploitation of their speed characteristics through specialized pulse sequences well suited for cardiac imaging. These advances have facilitated unprecedented acquisition times that now approach echocardiographic frame rates, while maintaining excellent image quality. This article provides a detailed overview of advanced pulse sequence technology and approaches currently taken to maximize speed performance and image quality. In particular, segmented K-space techniques that include single-echo and multiecho spoiled gradient-echo imaging as well as steady-state free precession imaging are discussed. Finally, spiral and fast spin-echo techniques are explored. Examples of common applications of these pulse sequences are presented.
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Affiliation(s)
- S B Reeder
- Department of Radiology, Stanford University, California, USA
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Abstract
Comprehensive cardiac assessment embraces virtually every imaging modality and includes information about coronary vascular anatomy as well as cardiac morphology, function, perfusion, metabolism, and tissue characterization. Through sophisticated computer processing and image analysis, newer imaging technologies such as computed tomography (CT), magnetic resonance (MR), MR spectroscopy, and positron emission tomography now provide quantitative information that may obviate more invasive angiographic assessment. Currently, no single imaging technology realizes all questions relating to cardiac form and function, and many of the technologies overlap in the content and quality of information they provide. This overview seeks to provide a broad perspective on current cardiac imaging, articulating the benefits of various technologies and their limitations.
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Affiliation(s)
- J G Goldin
- Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA 90095-1721, USA
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Abstract
Imaging algorithms in congenital heart disease, as in the patient with acquired heart diseases continue to evolve, with more and more information gleaned noninvasively. The emphasis will be on the newer aspects of imaging, not cross sectional echocardiography with color Doppler.
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Affiliation(s)
- J Russell
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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