1
|
Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:119-82. [DOI: 10.1016/j.echo.2014.11.015] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
2
|
Which cardiovascular magnetic resonance planes and sequences provide accurate measurements of branch pulmonary artery size in children with right ventricular outflow tract obstruction? Int J Cardiovasc Imaging 2013; 30:329-38. [PMID: 24272287 DOI: 10.1007/s10554-013-0328-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 11/12/2013] [Indexed: 10/26/2022]
Abstract
Children with right ventricular outflow tract obstructive (RVOTO) lesions require precise quantification of pulmonary artery (PA) size for proper management of branch PA stenosis. We aimed to determine which cardiovascular magnetic resonance (CMR) sequences and planes correlated best with cardiac catheterization and surgical measurements of branch PA size. Fifty-five children with RVOTO lesions and biventricular circulation underwent CMR prior to; either cardiac catheterization (n = 30) or surgery (n = 25) within a 6 month time frame. CMR sequences included axial black blood, axial, coronal oblique and sagittal oblique cine balanced steady-state free precession (bSSFP), and contrast-enhanced magnetic resonance angiography (MRA) with multiplanar reformatting in axial, coronal oblique, sagittal oblique, and cross-sectional planes. Maximal branch PA and stenosis (if present) diameter were measured. Comparisons of PA size on CMR were made to reference methods: (1) catheterization measurements performed in the anteroposterior plane at maximal expansion, and (2) surgical measurement obtained from a maximal diameter sound which could pass through the lumen. The mean differences (Δ) and intra class correlation (ICC) were used to determine agreement between different modalities. CMR branch PA measurements were compared to the corresponding cardiac catheterization measurements in 30 children (7.6 ± 5.6 years). Reformatted MRA showed better agreement for branch PA measurement (ICC > 0.8) than black blood (ICC 0.4-0.6) and cine sequences (ICC 0.6-0.8). Coronal oblique MRA and maximal cross sectional MRA provided the best correlation of right PA (RPA) size with ICC of 0.9 (Δ -0.1 ± 2.1 mm and Δ 0.5 ± 2.1 mm). Maximal cross sectional MRA and sagittal oblique MRA provided the best correlate of left PA (LPA) size (Δ 0.1 ± 2.4 and Δ -0.7 ± 2.4 mm). For stenoses, the best correlations were from coronal oblique MRA of right pulmonary artery (RPA) (Δ -0.2 ± 0.8 mm, ICC 0.9) and sagittal oblique MRA of left pulmonary artery (LPA) (Δ 0.2 ± 1.1 mm, ICC 0.9). CMR PA measurements were compared to surgical measurements in 25 children (5.4 ± 4.8 years). All MRI sequences demonstrated good agreement (ICC > 0.8) with the best (ICC 0.9) from axial cine bSSFP for both RPA and LPA. Maximal cross sectional and angulated oblique reformatted MRA provide the best correlation to catheterization for measurement of branch PA's and stenosis diameter. This is likely due to similar angiographic methods based on reformatting techniques that transect the central axis of the arteries. Axial cine bSSFP CMR was the best surgically measured correlate of PA branch size due to this being a measure of stretched diameter. Knowledge of these differences provides more precise PA measurements and may aid catheter or surgical interventions for RVOTO lesions.
Collapse
|
3
|
Kutty S, Kuehne T, Gribben P, Reed E, Li L, Danford DA, Beerbaum PB, Sarikouch S. Ascending Aortic and Main Pulmonary Artery Areas Derived From Cardiovascular Magnetic Resonance as Reference Values for Normal Subjects and Repaired Tetralogy of Fallot. Circ Cardiovasc Imaging 2012; 5:644-51. [DOI: 10.1161/circimaging.112.973073] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cardiac magnetic resonance (CMR) imaging is an important clinical tool for serial follow-up of patients with congenital heart disease, but normative data for great vessel dimensions in pediatric subjects are scarce. We investigated the ascending aortic (AO) and main pulmonary artery dimensions in normal children and young adults in comparison with a cohort of patients with repaired tetralogy of Fallot (TOF).
Methods and Results—
Subjects were prospectively enrolled for cardiac magnetic resonance after a standardized protocol in 14 participating centers of the German Competence Network for Congenital Heart Defects. All studies were performed in 1.5-T scanners and used single-slice multiphase acquisitions steady-state free precession and velocity-encoded cine. AO and main pulmonary artery areas were measured. The cohort consisted of 483 subjects: 105 normal controls (55 men; 50 women; and median age, 14 years) and 378 patients with repaired TOF (210 men; 168 women; and median age, 16 years). Among TOF, 35 (9%) had pulmonary atresia, 98 (26%) had a palliative procedure before repair, the mean age at repair was 2.9 years, and 82 (23%) used a transannular patch repair. Great vessel areas correlated well with body surface area and age in controls and reference Z-score values were derived. Z scores for ascending AO areas were larger in TOF compared with controls (mean Z score =1.95,
P
=0.001). In TOF, pulmonary atresia (
P
=0.003), male sex (
P
=0.01) and previous palliations (
P
=0.046) were associated with larger AO areas. Main pulmonary artery area Z scores in surgically modified TOF were smaller on an average than controls (mean Z score =−0.293
P
=0.001) but not small to the same extent as the AO was large.
Conclusions—
This study provides cardiac magnetic resonance reference Z scores for great vessel areas in normal children and adolescents in comparison with a large contemporary cohort of repaired TOF. Male sex, pulmonary atresia, and previous palliations emerged as predictors for larger AO dimensions in TOF.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00266188.
Collapse
Affiliation(s)
- Shelby Kutty
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| | - Titus Kuehne
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| | - Paul Gribben
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| | - Eric Reed
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| | - Ling Li
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| | - David A. Danford
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| | - Philipp B.J. Beerbaum
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| | - Samir Sarikouch
- From the Division of Pediatric Cardiology, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE (S.K., P.G., E.R., L.L., D.A.D.); Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (T.K.); Department for Radiology and Pediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (P.B.J.B.); and Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover
| |
Collapse
|
4
|
Cardiac MRI in Congenital Heart Disease - Our Experience. Med J Armed Forces India 2011; 61:57-62. [PMID: 27407705 DOI: 10.1016/s0377-1237(05)80122-4] [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: 08/16/2004] [Accepted: 12/15/2004] [Indexed: 11/21/2022] Open
Abstract
A significant recent advance that has occurred world over in the continuously evolving field of Magnetic Resonance Imaging (MRI) practice is the introduction of Cardiac applications. Cardiac MRI has moved to the centre stage of clinical management strategy by non-invasively imaging the structure as well as function of the heart. It has a wide range of specific applications such as delineation of morphological anatomy, quantification of flow and pressure across cardiac valve dysfunction, evaluation of myocardial function, assessment of infarcts, mapping coronary arteries and so on. Evaluation of congenital heart disease (CHD) is an important application of Cardiac MRI since the morphological details of chambers, septum, defects and anomalous connections are depicted accurately. Besides, flow information across valves, chambers, outflow tracts and shunts are also provided. This article describes our experience in the use of cardiac MRI in congenital heart disease.
Collapse
|
5
|
Niwa K, Uchishiba M, Aotsuka H, Tateno S, Tobita K, Hamada H, Fujiwara T, Matsuo K. Pulmonary artery anatomy in congenital heart disease with decreased pulmonary blood flow by magnetic resonance imaging. Int J Angiol 2011. [DOI: 10.1007/bf01616182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
6
|
Nabo MMH, Hayabuchi Y, Inoue M, Watanabe N, Sakata M, Kagami S. Assessment of modified Blalock-Taussig shunt in children with congenital heart disease using multidetector-row computed tomography. Heart Vessels 2010; 25:529-35. [PMID: 20878166 DOI: 10.1007/s00380-010-0007-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 12/03/2009] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess the feasibility of multidetector-row computed tomography (MDCT) for the evaluation of modified Blalock-Taussig (B-T) shunt in children with congenital heart disease associated with reduced pulmonary blood flow. A total of 25 consecutive patients (mean age, 2.6 ± 3.6 years; range, 2 months-16 years) underwent MDCT angiography of the thorax with a 16-detector row scanner prior to cardiac catheterization. A total of 39 shunts (right, 22; left, 17) were included in the study. Conventional angiographic findings were used as the gold standard for the detection of B-T shunts. Shunt diameter was measured quantitatively and independently at four sites (the subclavian artery site, the pulmonary artery site, the widest site, and the stenotic site) on MDCT and on conventional invasive angiography. All B-T shunts were depicted on multiplanar reconstruction (MPR), maximum intensity projection (MIP), curved planar reconstruction (CPR), and three-dimensional volume-rendered (VR) images, enabling evaluation in all patients except for one with occluded shunt. There were excellent correlations between MDCT- and conventional angiography-based measurements of shunt diameter at the subclavian artery site, pulmonary artery site, and the widest site (R² = 0.46, 0.74 and 0.64, respectively; p < 0.0001 for each), although systematic overestimation was observed for MDCT (mean percentage of overestimation, 23.1 ± 32.4%). Stenotic site diameter and degree of stenosis showed a mild correlation (R² = 010 and 0.25, respectively; p < 0.01 for each). This study demonstrates that MDCT is a promising tool for the detection of lesions in B-T shunts.
Collapse
|
7
|
Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 450] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
8
|
Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 232] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
9
|
Ba HO, Marini D, Kammache I, Ou P, Elie C, Boudjemline Y, Bonnet D, Agnoletti G. Preoperative evaluation of candidates for total cavopulmonary connection: The role of echocardiography and cardiac catheterization. Arch Cardiovasc Dis 2009; 102:303-9. [DOI: 10.1016/j.acvd.2009.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/29/2009] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
|
10
|
ACR appropriateness criteria on suspected congenital heart disease in adults. J Am Coll Radiol 2008; 5:97-104. [PMID: 18242524 DOI: 10.1016/j.jacr.2007.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Indexed: 10/22/2022]
Abstract
The number of adults with congenital heart disease is increasing in North America. This is attributable to a variety of factors, including improvements in surgical techniques and increases in immigration. Cardiac imaging is critical for the initial assessment of adults with newly suspected congenital heart disease as well as for the serial assessment of adults with known congenital heart disease. Chest radiography and echocardiography continue to be the initial tools used to evaluate adult congenital heart disease. However, cardiac computed tomography and magnetic resonance imaging have significantly improved over the years and have become integral to the evaluation of adult congenital heart disease, often precluding the necessity for invasive cardiac catheterization. Noninvasive imaging is particularly useful for the surveillance of patients with surgically corrected congenital heart disease, who often require 2 or more additional operations.
Collapse
|
11
|
Ordovás KG, Tan C, Reddy GP, Weber OM, Lu Y, Higgins CB. Disparity between ratios of diameters and blood flows in central pulmonary arteries in postoperative congenital heart disease using MRI. J Magn Reson Imaging 2007; 25:721-6. [PMID: 17335010 DOI: 10.1002/jmri.20863] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare the relative severity of stenoses of right or left pulmonary arteries with differences in flow to each lung after repair of congenital heart disease (CHD). MATERIALS AND METHODS A total of 15 patients with postoperative congenital heart disease underwent MRI to evaluate branch pulmonary artery stenoses. Spin-echo images and MR angiography were used to assess morphology, and velocity-encoded cine (VEC) MRI was used to measure flow in the right and left pulmonary arteries. The ratios of the narrowest diameters of the right to left pulmonary arteries (R/L size) and right to left pulmonary arterial flow (R/L flow) were compared using Spearman's correlation. F test was used to assess the significance of the regression coefficients. RESULTS R/L size ratio varied from 0.50 to 2.66, while the R/L flow ratio varied from 0.36 to 12.02. There was an exponential relationship between R/L size and R/L flow, with r2=0.78 and P=0.001. However, severity of morphologic stenoses was not clinically useful for predicting flow reduction. Prediction residuals ranged from -136% to 54% of the true R/L flow. CONCLUSION Anatomical evaluation of the pulmonary arteries does not predict accurately differential blood flow in patients with pulmonary stenoses. Therefore, blood flow measurements are essential when considering the need for further surgical or interventional procedures.
Collapse
Affiliation(s)
- Karen G Ordovás
- Department of Radiology, University of California, San Francisco, San Francisco, California 94143-0628, USA
| | | | | | | | | | | |
Collapse
|
12
|
Bremerich J, Pater S, Buser PT. Magnetic resonance imaging of acquired heart disease: evaluation of structure. Semin Roentgenol 2003; 38:314-9. [PMID: 14621373 DOI: 10.1016/s0037-198x(03)00056-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jens Bremerich
- Departments of Radiology, and Cardiology, University of Basel, Basel, Switzerland
| | | | | |
Collapse
|
13
|
Choi BW, Park YH, Lee JK, Kim DJ, Kim MJ, Choe KO. Patency of cavopulmonary connection studied by single phase electron beam computed tomography. Int J Cardiovasc Imaging 2003; 19:447-55. [PMID: 14609197 DOI: 10.1023/a:1025808900239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The shunt patency and anatomic alteration of central PA after cavopulmonary connection was assessed by one phase electron-beam computed tomography (EBCT) METHODS: Thirteen patients that received a bi-directional cavo-pulmonary shunt (BCPS, n = 7) or total cavo-pulmonary connection (TCPC, n = 6) were included. The patency of the shunt and the anatomy of intra-pericardial PA were evaluated by EBCT, and compared by angiography and echocardiography. RESULTS EBCT accurately evaluated shunt patency and the anatomy of the intra-pericardial PA, except for the incorrect diagnosis of SVC-PA shunt patency and peripheral pulmonary stenosis in two TCPC patients. Both of these patients had bilateral SVC and received either bilateral BCPS or ligation of the left SVC respectively. The baffle between the IVC and PA was partly opacified through a fenestration of the baffle, but was not opacified in two patients without fenestration. CONCLUSION EBCT accurately evaluated shunt patency and the anatomy of central PA, however, the accuracy was limited in two cases with bilateral SVC. The opacification of the intra-atrial baffle was insufficient in TCPC cases. Multi-phase CT angiography may overcome this limitation in this patient subset.
Collapse
MESH Headings
- Cardiac Catheterization
- Child
- Child Welfare
- Child, Preschool
- Contrast Media
- Echocardiography
- Female
- Heart Atria/diagnostic imaging
- Heart Atria/physiopathology
- Heart Bypass, Right
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Hepatic Veins/diagnostic imaging
- Hepatic Veins/physiopathology
- Humans
- Infant
- Infant Welfare
- Injections, Intravenous
- Male
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Postoperative Complications/physiopathology
- Pulmonary Artery/diagnostic imaging
- Pulmonary Artery/physiopathology
- Pulmonary Circulation/physiology
- Pulmonary Valve Stenosis/diagnosis
- Pulmonary Valve Stenosis/physiopathology
- Pulmonary Valve Stenosis/surgery
- Regional Blood Flow/physiology
- Retrospective Studies
- Statistics as Topic
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Patency/physiology
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Inferior/physiopathology
- Vena Cava, Superior/diagnostic imaging
- Vena Cava, Superior/physiopathology
Collapse
Affiliation(s)
- Byoung Wook Choi
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
14
|
Reddy GP, Higgins CB. Magnetic resonance imaging of congenital heart disease: evaluation of morphology and function. Semin Roentgenol 2003; 38:342-51. [PMID: 14621376 DOI: 10.1016/s0037-198x(03)00055-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gautham P Reddy
- Department of Radiology, Suite M396, 505 Parnassus Avenue, Box 0628, University of California, San Francisco, San Francisco, CA 94143-0628, USA
| | | |
Collapse
|
15
|
Powell AJ, Chung T, Landzberg MJ, Geva T. Accuracy of MRI evaluation of pulmonary blood supply in patients with complex pulmonary stenosis or atresia. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 2000; 16:169-74. [PMID: 11144770 DOI: 10.1023/a:1006486225047] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Detailed imaging of pulmonary artery (PA) anatomy and significant aorto-pulmonary collaterals (APCs) is crucial for surgical planning and follow-up in patients with complex congenital heart disease (CHD) and pulmonary stenosis or atresia. Because examination by echocardiography is often technically limited and catheterization is invasive, this study evaluated the diagnostic accuracy of magnetic resonance imaging (MRI) as an alternate non-invasive tool. Thirteen patients (median age 28 years, range: 1-44 years) underwent both cardiac catheterization and MRI within a median of two months (range 0.1-8 months). Diagnoses included tetralogy of Fallot (TOF) with pulmonary atresia (n = 8), TOF with pulmonary stenosis (n = 2), single left ventricle with pulmonary stenosis (n = 2), and complex heterotaxy with pulmonary stenosis (n = 1). The MRI sequences used in this study were ECG-gated spin echo and gradient echo sequences acquired in multiple planes. Compared to catheterization, MRI had 100% sensitivity and specificity for the diagnosis of main PA (n = 6) and branch PA (n = 13) hypoplasia or stenosis, as well as discontinuous (n = 4) or absent (n = 10) branch PAs. There was complete agreement between catheterization and MRI identification of significant APCs (n = 18). Main PA atresia was noted by MRI in four patients but was not definitively seen by catheterization in any. MRI but not catheterization precisely defined the distance between discontinuous PAs and their relationship to other mediastinal structures. In conclusion, cardiac MRI is a reliable non-invasive imaging modality to define PA and APC anatomy in patients with complex pulmonary stenosis or atresia.
Collapse
Affiliation(s)
- A J Powell
- Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA
| | | | | | | |
Collapse
|
16
|
Ichida F, Hashimoto I, Tsubata S, Hamamichi Y, Uese K, Murakami A, Miyawaki T. Evaluation of pulmonary blood supply by multiplanar cine magnetic resonance imaging in patients with pulmonary atresia and severe pulmonary stenosis. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1999; 15:473-81. [PMID: 10768742 DOI: 10.1023/a:1006391814569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to assess the capability of multiplanar cine magnetic resonance imaging (MRI) for evaluating pre- and post-operative pulmonary circulation in patients with pulmonary atresia and severe pulmonary stenosis. Seventy-three multiplanar cine MRIs were performed in 30 patients, aged 1 month to 7 years (mean age, 27 months). The morphology and size of the central pulmonary arteries (PA), source of the major aortopulmonary collateral arteries (MAPCA), patency of Blalock-Taussig (BT) shunt vessels, and the post-operative pulmonary circulation were assessed. The accuracy of cine MRI was compared with that of angiography in all patients. The PA was visualized to the first hilar branch in 21 patients, but not in 8 patients in whom the central PA was absent. On follow-up MRI, PA growth was measured, and the results showed excellent correlation with the results obtained by angiography. In 17 patients who had undergone 23 BT shunt operations, cine MRI correctly demonstrated all patient shunts and 5 of 6 stenotic lesions. Multiplanar cine MRI provided excellent detail of the peripheral PA in all patients, 7 of 8 peripheral pulmonary stenoses, 3 of 4 nonconfluent pulmonary arteries, and 2 of 3 PA obstructions. Although the sources of MAPCA were identified in 7 of 9 patients, the distal connection of the MAPCA was not detected in all patients. Seven patients were reexamined after pulmonary plasty; they exhibited normal pulmonary flow patterns. Multiplanar cine MRI provides high-resolution imaging of PA with dynamic visualization of flow and is an effective noninvasive technique for evaluating pre- and post-operative patients with pulmonary atresia and severe pulmonary stenosis.
Collapse
Affiliation(s)
- F Ichida
- Department of Pediatrics, Toyama Medical & Pharmaceutical University, Sugitani, Japan
| | | | | | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- P M Weinberg
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA
| | | | | |
Collapse
|
18
|
Abstract
TTE with color flow imaging remains the most appropriate initial method for imaging CHD in adults. In many patients with minor abnormalities, this will be the only imaging required. For complicated intracardiac anomalies not well shown by TTE, TEE or MRI are usually adequate with the choice of technique being dependent on the availability of appropriate equipment and expertise. For great vessel abnormalities, further evaluation with MRI and MRA is most appropriate. In patients suspected of having significant systemic or pulmonary venous abnormalities or abnormalities of the aortic arch, MRI and MRA should be regarded as the definitive imaging technique. MRI and MRA are robust methods for evaluating intracardiac disease and can provide accurate information on cardiac chamber anatomy relationships, valvar lesions, and shunts. However, in most patients, this information is provided more rapidly and cost effectively by color Doppler echocardiography.
Collapse
Affiliation(s)
- G G Hartnell
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | | |
Collapse
|
19
|
Abstract
Clearly, both echocardiography and MRI play vital roles in the diagnosis and management of children with congenital heart defects. 2-D Doppler echocardiography is very easy to use in a vast array of clinical situations. The accuracy of the anatomic and hemodynamic findings are well accepted. In comparative studies, 2-D Doppler echocardiography appears preferable for intracardiac anatomy, whereas MRI appears preferable for extracardiac anatomy. In certain patients, Doppler echocardiography may not be able to optimally obtain the anatomic or hemodynamic information, and MRI should be used in these particular cases.
Collapse
Affiliation(s)
- G R Marx
- Department of Cardiology, Children's Hospital, Boston, MA 02115, USA
| | | |
Collapse
|
20
|
Abstract
Cardiovascular MR imaging is unique in its ability to combine anatomic, physiologic, and functional information in a single examination. Established applications in the pediatric population include the evaluation of the child with a suspected thoracic aortic arch anomaly, vascular compression of the airway, coarctation of the aorta, pulmonary arterial and venous abnormalities, and cardiac or paracardiac masses. The increasing availability of radiologists with the knowledge and commitment to cardiac imaging will allow this exciting technique to thrive in the future, to the benefit of our patients.
Collapse
Affiliation(s)
- S C Berlin
- Department of Radiology, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Ohio, USA
| |
Collapse
|
21
|
|
22
|
Duerinckx A, Atkinson D, Klitzner TS, Perloff J, Drinkwater D, Laks H. MR imaging of surgical complications of systemic-to-pulmonary artery shunts. Magn Reson Imaging 1996; 14:1099-105. [PMID: 9071002 DOI: 10.1016/s0730-725x(96)00112-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with a systemic-to-pulmonary artery shunt and positive findings on traditional imaging modalities such as chest X-ray, echocardiography, or cardiac angiography often can benefit from additional noninvasive imaging with magnetic resonance imaging (MRI). Diagnostic dilemmas encountered include: pseudoaneurysms, contained fluid collection (seroma) surrounding a shunt, and stenosis of the shunt anastomoses. MRI studies using traditional cardiac-triggered spin-echo (SE) imaging and the newer breathhold MRI studies with k-space segmented gradient-recalled echo (GRE) imaging can greatly help resolve diagnostic dilemmas. By combining different MR imaging techniques it becomes possible to clearly distinguish between pseudoaneurysms and seroma, to exclude an active leak and to sometimes visualize the distal anastomosis with more precision than conventional angiography. MRI is often able to add information needed for clinical decision making prior to surgical repair.
Collapse
Affiliation(s)
- A Duerinckx
- Radiology Service, VA Medical Center, West Los Angeles, CA 90073, USA
| | | | | | | | | | | |
Collapse
|