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CLINICAL STUDY: NEW METHODS

Ultrafast three-dimensional contrast-enhanced magnetic resonance angiography and imaging in the diagnosis of partial anomalous pulmonary venous drainage

Victor A. Ferrari, MD, FACC^*, Craig H. Scott, MD, FACC^*, George A. Holland, MD , Leon Axel, PhD, MD and Martin St. John Sutton, FRCP, FACC^*

^* Adult Congenital Heart Disease Program, Cardiovascular Division, Department of Medicine (Cardiovascular Division), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

Manuscript received September 20, 1999; revised manuscript received November 3, 2000, accepted December 12, 2000.

Reprint requests and correspondence: Dr. Victor A. Ferrari, Cardiovascular Division, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
ferrariv{at}mail.med.upenn.edu

OBJECTIVES

The purpose of our study was to evaluate patients with suspected anomalous pulmonary veins (APVs) and atrial septal defects (ASDs) using fast cine magnetic resonance imaging (MRI) and ultrafast three-dimensional magnetic resonance angiography (MRA).

BACKGROUND

Precise anatomic definition of anomalous pulmonary and systemic veins, and the atrial septum are prerequisites for surgical correction of ASDs. Cardiac catheterization and transesophageal echocardiography (TEE) are currently used to diagnose APVs, but did not provide complete information in our patients.

METHODS

Twenty consecutive patients with suspected APVs were studied by MRA after inconclusive assessment by catheterization, TEE or both. The MRI images were acquired with a fast cine sequence and a novel ultrafast three-dimensional sequence before and after contrast injection.

RESULTS

Partial anomalous pulmonary venous drainage was demonstrated in 16 of 20 patients and was excluded in four patients. Magnetic resonance imaging correctly diagnosed APVs and ASDs in all patients (100%) who underwent surgery. For the diagnosis of APVs, the MRI and catheterization results agreed in 74% of patients and the MRI and TEE agreed in 75% of patients. For ASDs, MRI agreed with catheterization and TEE in 53% and 83% of patients, respectively.

CONCLUSIONS

Fast cine MRI with three-dimensional contrast-enhanced MRA provides rapid and comprehensive anatomic definition of APVs and ASDs in patients with adult congenital heart disease in a single examination.

Abbreviations and Acronyms   3D = three-dimensional   APV = anomalous pulmonary vein   APVD = anomalous pulmonary venous drainage   ASD = atrial septal defect   IVC = inferior vena cava   MRA = magnetic resonance angiography   MRI = magnetic resonance imaging   PA = pulmonary artery   Qp = pulmonary blood volume flows   Qs = systemic blood volume flows   Qp/Qs = shunt fraction   RUL = right upper lobe   SPGR = spoiled gradient   SVASD = sinus venosus atrial septal defect   SVC = superior vena cava   TE = echo time   TEE = transesophageal echocardiography   TR = repetition time   TTE = transthoracic echocardiography

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