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  • Title: Contrast-enhanced MR angiography of cavopulmonary connections in adult patients with congenital heart disease.
    Author: Wagner M, Nguyen KL, Khan S, Mirsadraee S, Satou GM, Aboulhosn J, Finn JP.
    Journal: AJR Am J Roentgenol; 2012 Nov; 199(5):W565-74. PubMed ID: 23096200.
    Abstract:
    OBJECTIVE: The purpose of this study is to evaluate combined time-resolved and high-spatial resolution contrast-enhanced MR angiography (MRA) for assessment of cavopulmonary connections in adult patients with congenital heart disease. MATERIALS AND METHODS: Twenty-eight adults with various surgical cavopulmonary connections (Glenn shunt and Fontan connection) underwent high-spatial-resolution contrast-enhanced MRA (voxel size, 1.95 mm(3); temporal resolution, 22 seconds) and time-resolved contrast-enhanced MRA (voxel size, 6.5-9.3 mm(3); temporal resolution, < 1.2 seconds). Ten patients had 2D phase contrast flow quantification measurements performed at the same setting. Two readers independently assessed anatomic dimensions of cavopulmonary connections (using high-spatial-resolution contrast-enhanced MRA) and pulmonary artery (PA) perfusion patterns (using time-resolved contrast-enhanced MRA). RESULTS: High-spatial-resolution contrast-enhanced MRA yielded diagnostic-quality images for morphologic assessment of cavopulmonary connections in 27 of 28 (96%) patients. The anatomic dimensions (cross-sectional area) of the PA and cavopulmonary connections showed a wide variation (right PA, 0.99-5.67 cm(2); left PA, 0.80-5.69 cm(2); Glenn shunt, 0.93-6.94 cm(2); and Fontan connection, 1.25-6.67 cm(2)). The anatomic dimensions could be assessed with excellent interobserver agreement on high-spatial-resolution contrast-enhanced MRA (r = 0.895). Time-resolved contrast-enhanced MRA yielded diagnostic-quality images in all patients and enabled characterization of PA perfusion via the superior vena cava as follows: preferential inflow to the right PA (n = 12), preferential inflow to the left PA (n = 5), and balanced inflow to the right and left PA (n = 11). In those patients who had technically successful flow quantification measurements, phase contrast data confirmed patency of the cavopulmonary connections. CONCLUSION: Combined time-resolved contrast-enhanced MRA and high-spatial-resolution contrast-enhanced MRA allowed detailed morphologic and dynamic evaluation of cavopulmonary connections in adult patients with congenital heart disease. A wide variation in anatomic dimensions and perfusion patterns was confidently identified in this patient population.
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