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Flow-sensitive four-dimensional magnetic resonance imaging facilitates and improves the accurate diagnosis of partial anomalous pulmonary venous drainage

Published online by Cambridge University Press:  19 April 2011

Sarah Nordmeyer*
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Felix Berger
Affiliation:
Department of Paediatric Cardiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
Titus Kuehne
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany Department of Paediatric Cardiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
Eugénie Riesenkampff
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
*
Correspondence to: Dr med. S. Nordmeyer, Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 30 4593 2800; Fax: +49 30 45932900; E-mail: snordmeyer@dhzb.de

Abstract

Objectives

To assess if flow-sensitive four-dimensional velocity-encoded cine magnetic resonance imaging adds value in diagnosing patients with suspected partial anomalous pulmonary venous drainage.

Methods

In six patients with echocardiographically suspected partial anomalous pulmonary venous drainage, anatomy was evaluated using standard magnetic resonance imaging including angiography. Functional analysis included shunt calculations from flow measurements. We used four-dimensional velocity-encoded cine magnetic resonance imaging for visualisation of maldraining pulmonary veins and quantification of flow via the maldraining veins and interatrial communications, if present.

Results

In all patients, the diagnosis of partial anomalous pulmonary venous drainage was confirmed by standard magnetic resonance imaging. Shunt volumes ranged from 1.4:1 to 4.7:1. Drainage sites were the superior caval vein (n = 5) or the vertical vein (n = 1). Multiple maldraining pulmonary veins were found in three patients. Pulmonary arteries and veins could be clearly distinguished by selective visualisation using four-dimensional velocity-encoded cine magnetic resonance imaging. Flow measured individually in maldraining pulmonary veins in six patients and across the interatrial communication in three patients revealed a percentage of the overall shunt volume of 30–100% and 58–70%, respectively.

Conclusion

Selective visualisation of individual vessels and their flow characteristics by four-dimensional velocity-encoded cine magnetic resonance imaging facilitates in distinguishing adjacent pulmonary arteries and veins and thus improves the accurate diagnosis of maldraining pulmonary veins. By detailed quantification of shunt volumes, additional information for planning of treatment strategies is provided. This method adds clinical value and might replace contrast-enhanced magnetic resonance angiography in these patients in the future.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

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References

1.Riesenkampff, EM, Schmitt, B, Schnackenburg, B, et al. Partial anomalous pulmonary venous drainage in young pediatric patients: the role of magnetic resonance imaging. Pediatr Cardiol 2009; 30: 458464.CrossRefGoogle Scholar
2.Festa, P, Ait-Ali, L, Cerillo, AG, De Marchi, D, Murzi, B. Magnetic resonance imaging is the diagnostic tool of choice in the preoperative evaluation of patients with partial anomalous pulmonary venous return. Int J Cardiovasc Imaging 2006; 22: 685693.CrossRefGoogle ScholarPubMed
3.Beerbaum, P, Parish, V, Bell, A, Gieseke, J, Korperich, H, Sarikouch, S. Atypical atrial septal defects in children: noninvasive evaluation by cardiac MRI. Pediatr Radiol 2008; 38: 11881194.CrossRefGoogle ScholarPubMed
4.Prasad, SK, Soukias, N, Hornung, T, et al. Role of magnetic resonance angiography in the diagnosis of major aortopulmonary collateral arteries and partial anomalous pulmonary venous drainage. Circulation 2004; 109: 207214.CrossRefGoogle ScholarPubMed
5.Markl, M, Chan, FP, Alley, MT, et al. Time-resolved three-dimensional phase-contrast MRI. J Magn Reson Imaging 2003; 17: 499506.CrossRefGoogle ScholarPubMed
6.Uribe, S, Beerbaum, P, Sorensen, TS, Rasmusson, A, Razavi, R, Schaeffter, T. Four-dimensional (4D) flow of the whole heart and great vessels using real-time respiratory self-gating. Magn Reson Med 2009; 62: 984992.CrossRefGoogle ScholarPubMed
7.Brix, L, Ringgaard, S, Rasmusson, A, Sorensen, TS, Kim, WY. Three dimensional three component whole heart cardiovascular magnetic resonance velocity mapping: comparison of flow measurements from 3D and 2D acquisitions. J Cardiovasc Magn Reson 2009; 11: 3.CrossRefGoogle ScholarPubMed
8.Nordmeyer, S, Riesenkampff, E, Crelier, G, et al. Flow-sensitive four-dimensional cine magnetic resonance imaging for offline blood flow quantification in multiple vessels: a validation study. J Magn Reson Imaging 2010; 32: 677683.CrossRefGoogle ScholarPubMed
9.Devos, DG, Kilner, PJ. Calculations of cardiovascular shunts and regurgitation using magnetic resonance ventricular volume and aortic and pulmonary flow measurements. European Radiol 2010; 20: 410421.CrossRefGoogle ScholarPubMed
10.Martin, DR. Nephrogenic systemic fibrosis. Pediatr Radiol 2008; 38 Suppl 1: S125S129.CrossRefGoogle ScholarPubMed