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Muscogiuri G, Suranyi P, Eid M, Varga-Szemes A, Griffith L, Pontone G, Schoepf UJ, De Cecco CN. Pediatric Cardiac MR Imaging:: Practical Preoperative Assessment. Magn Reson Imaging Clin N Am 2019; 27:243-262. [PMID: 30910096 DOI: 10.1016/j.mric.2019.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Prevalence of patients with congenital heart disease (CHD) is rapidly increasing due to continuous advancements in diagnostic techniques and medical or surgical treatment approaches. Along with cardiac computed tomography angiography, cardiac magnetic resonance (CMR) serves as a fundamental imaging modality for pre-surgical planning in patients with CHD, as CMR allows for the evaluation of cardiac and great vessel anatomy, biventricular function, flow dynamics, and tissue characterization. This information is essential for risk-assessment and optimal timing of surgical interventions. This article discusses the current role of pediatric cardiac MR imaging as a practical preoperative assessment tool in the pediatric population.
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Affiliation(s)
- Giuseppe Muscogiuri
- Centro Cardiologico Monzino, IRCCS, Via Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milano MI, Italy; Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Rome, Italy
| | - Pal Suranyi
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Marwen Eid
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Lewis Griffith
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Via Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milano MI, Italy
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Dr, MUSC, Charleston, SC 29401, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Emory Healthcare, Inc., 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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Louvet A, Duconseille AC, Lazard P. Contrast-enhanced magnetic resonance angiography of patent ductus arteriosus in a dog. J Small Anim Pract 2010; 51:451-3. [DOI: 10.1111/j.1748-5827.2010.00970.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Magnetic Resonance Angiography With Midsagittal Saturation for the Assessment of Blood Flow From Superficial Temporal Artery-to-Middle Cerebral Artery Bypass. J Comput Assist Tomogr 2010; 34:89-92. [DOI: 10.1097/rct.0b013e3181ac914e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 628] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rehwald WG, Wagner A, Sievers B, Kim RJ, Judd RM. Cardiovascular MRI: its current and future use in clinical practice. Expert Rev Cardiovasc Ther 2007; 5:307-21. [PMID: 17338674 DOI: 10.1586/14779072.5.2.307] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular magnetic resonance (CMR) imaging is a comprehensive clinical tool for assessing a large variety of cardiovascular diseases. Using the clinical service of the Duke Cardiovascular Magnetic Resonance Center as an example, we describe how to perform image contractile function, myocardial perfusion at stress and rest, myocardial viability, cardiovascular morphology, vascular anatomy and blood flow tests. The emergence of successful dedicated CMR services presents an opportunity to optimize patient throughput by streamlining the user interface of CMR scanners, standardizing the viewing format and reporting software, and customizing training programs to focus on the standardized CMR approaches. Accordingly, we discuss potential pathways to create these standards. Finally, we discuss several promising new CMR techniques we expect will complement existing clinical procedures.
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Makaryus AN, Aronov I, Diamond J, Park CH, Rosen SE, Stephen B. Survival to the Age of 52 Years in a Man with Unrepaired Tetralogy of Fallot. Echocardiography 2004; 21:631-7. [PMID: 15488093 DOI: 10.1111/j.0742-2822.2004.03160.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect during infancy. It is composed of a ventricular septal defect, an overriding aorta, obstruction of right ventricular outflow, and right ventricular hypertrophy. Most patients experience cyanosis at birth and die in childhood without surgical intervention. The rate of survival at 40 years without surgical correction is only 3%. We present the case of a man with tetralogy of Fallot who survived until the age of 52 years without surgical intervention.
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Affiliation(s)
- Amgad N Makaryus
- Division of Cardiology, North Shore-Long Island Jewish Health System, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article. J Am Soc Echocardiogr 2003. [DOI: 10.1016/j.echo.2003.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol 2003; 42:954-70. [PMID: 12957449 DOI: 10.1016/s0735-1097(03)01065-9] [Citation(s) in RCA: 341] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation 2003; 108:1146-62. [PMID: 12952829 DOI: 10.1161/01.cir.0000073597.57414.a9] [Citation(s) in RCA: 517] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Greil GF, Powell AJ, Gildein HP, Geva T. Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies. J Am Coll Cardiol 2002; 39:335-41. [PMID: 11788228 DOI: 10.1016/s0735-1097(01)01730-2] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the diagnostic value of gadolinium (Gd)-enhanced three-dimensional (3D) magnetic resonance angiography (MRA) in patients with congenital and acquired anomalies of the pulmonary and systemic veins. BACKGROUND Gadolinium-enhanced 3D MRA is a fast magnetic resonance imaging technique that has shown great promise in the evaluation of large and medium-sized arteries. However, its application to venous anomalies has not been studied in detail. METHODS The study retrospectively analyzed all patients who underwent Gd-enhanced 3D MRA examination from January 1998 through January 2001, were diagnosed with anomalies of the pulmonary or systemic veins and had additional diagnostic data available for comparison with the MRA findings. RESULTS Sixty-one patients (age 1 day to 60 years) were included. Image acquisition was completed in 29 +/- 6.9 s. Pulmonary venous anomalies were found in 37 patients, systemic venous anomalies in 17 patients and both pulmonary and systemic venous anomalies in 7 patients. Compared with available diagnostic information by other modalities, all known or suspected venous anomalies were imaged by 3D MRA. In three patients, catheterization did not detect anomalies of the pulmonary veins that were subsequently diagnosed by MRA. The 3D MRA diagnoses were followed by 10 interventional catheterization procedures and 15 operations. In 74% of patients, 3D MRA either diagnosed previously unsuspected venous anomalies (28%) or added new clinically important information (46%). The mechanism of pulmonary vein compression in eight patients was determined by MRA but not by other imaging modalities. Using a five-level grading system for MRA image quality (1 = nondiagnostic; 5 = excellent), the average grade was 4.6 +/- 0.6, with a 0.28 +/- 0.6 mean grade difference between two independent observers. CONCLUSIONS Gadolinium-enhanced 3D MRA is capable of rapidly and accurately diagnosing a wide spectrum of pulmonary and systemic venous anomalies and is a useful noninvasive alternative to diagnostic catheterization.
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Affiliation(s)
- Gerald F Greil
- Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA
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Abstract
Echocardiography and catheterization angiography suffer certain limitations in the evaluation of congenital heart diseases in adults, though these are overcome by MRI, in which a wide field-of view, unlimited multiplanar imaging capability and three-dimensional contrast-enhanced MR angiography techniques are used. In adults, recently introduced fast imaging techniques provide cardiac MR images of sufficient quality and with less artifacts. Ventricular volume, ejection fraction, and vascular flow measurements, including pressure gradients and pulmonary-to-systemic flow ratio, can be calculated or obtained using fast cine MRI, phase-contrast MR flow-velocity mapping, and semiautomatic analysis software. MRI is superior to echocardiography in diagnosing partial anomalous pulmonary venous connection, unroofed coronary sinus, anomalies of the pulmonary arteries, aorta and systemic veins, complex heart diseases, and postsurgical sequelae. Biventricular function is reliably evaluated with cine MRI after repair of tetralogy of Fallot, and Senning's and Mustard's operations. MRI has an important and growing role in the morphologic and functional assessment of congenital heart diseases in adolescents and adults.
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Affiliation(s)
- Y H Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Affiliation(s)
- M E Brickner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9047, USA
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Winterer JT, Lehnhardt S, Schneider B, Neumann K, Allmann KH, Laubenberger J, Langer M. MRI of heart morphology. Comparison of nongradient echo sequences with single- and multislice acquisition. Invest Radiol 1999; 34:516-22. [PMID: 10434183 DOI: 10.1097/00004424-199908000-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES A large variety of cardiac MRI sequences have been introduced for heart morphology evaluation. The aim of this study was to establish a practicable and robust examination protocol for standard high-field systems applying nongradient echo sequences with single- and multi-slice acquisition. METHODS Fifty-one patients received electrocardiogramgated MRI of the heart with "black-blood" preparation, comparing three single-slice and three multislice sequences with a T1-weighted turbo spin echo reference sequence. Demarcation of the left ventricular myocardium and cavity and the extent of flow and motion artifacts were assessed. RESULTS The myocardium and left ventricular cavity were depicted best with the single-slice T1- and T2-weighted turbo spin echo sequence. The nonbreath-hold multislice sequences produced marked artifacts and therefore were of poor diagnostic value. The TIRM haste sequence was best suited for fat suppression. The T2-weighted breath-hold single-shot sequence with half-Fourier imaging proved to be most appropriate for multislice imaging. CONCLUSIONS Sufficient depiction of heart morphology with comprehensive evaluation of signal changes can be achieved using nongradient spin echo and turbo spin echo sequences with breath-holding. For rational imaging of myocardial and heart chamber morphology, multislice and single-slice sequences should be combined.
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Affiliation(s)
- J T Winterer
- Department of Diagnostic Radiology, University Hospital Freiburg, Germany
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Abstract
Recent developments in MRI software and hardware have increased the speed and versatility of cardiac MRI by allowing image acquisition in a single breathhold. Many studies have shown that conventional cardiac MRI is as accurate as echocardiography or cardiac catheterization for diagnosing numerous cardiac conditions. In many cases cardiac MRI is the most accurate diagnostic technique but has not been widely adopted for routine cardiac imaging. One reason why the use of cardiac MRI has been limited is the long examination times required for conventional cardiac MRI. The development of better hardware, such as faster gradient amplifiers and dedicated surface coils, has allowed the implementation of much faster EKG-gated imaging sequences. These can be used in a single breathhold period, with a significant improvement in image quality compared with conventional sequences. Breathhold sequences can provide all the information provided by conventional cardiac MRI in a shorter time and with equal or better accuracy. Breathhold imaging will allow much wider application of MRI to routine cardiac diagnosis.
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Affiliation(s)
- G G Hartnell
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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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.
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Affiliation(s)
- G G Hartnell
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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