CLINICAL STUDY: MAGNETIC RESONANCE ANGIOGRAPHY
Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies
Gerald F. Greil, MD*,
Andrew J. Powell, MD, FACC* ,
Hans P. Gildein, MD* and
Tal Geva, MD, FACC*  ,*
* Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
Department of Radiology, Children’s Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
Manuscript received June 15, 2001;
revised manuscript received September 17, 2001,
accepted October 18, 2001.
* Reprint requests and correspondence: Dr. Tal Geva, Department of Cardiology, Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA.
tal.geva{at}tch.harvard.edu
OBJECTIVES: 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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Abbreviations and Acronyms
| | 3D | | three-dimensional | | CT | | computed tomography | | Gd | | gadolinium | | IVC | | inferior vena cava | | MIP | | maximal intensity projection | | MPR | | multiplanar reformatting | | MRA | | magnetic resonance angiography | | MRI | | magnetic resonance imaging | | PAPVC | | partially anomalous pulmonary venous connection | | SVC | | superior vena cava | | TAPVC | | totally anomalous pulmonary venous connection |
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