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STATE-OF-THE-ART PAPER

Anatomical and Functional Evaluation of Pulmonary Veins in Children by Magnetic Resonance Imaging

Lars Grosse-Wortmann, MD^_*,, Abdulmajeed Al-Otay, MD^_*,, Hyun Woo Goo, MD^_*, Christopher K. Macgowan, PhD^_*, John G. Coles, MD, Leland N. Benson, MD, Andrew N. Redington, MD and Shi-Joon Yoo, MD^_*,,_*

^_* Section of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, The University of Toronto, Toronto, Canada.

Manuscript received July 18, 2006; revised manuscript received September 18, 2006, accepted September 27, 2006.

^_* Reprint requests and correspondence: Dr. Shi-Joon Yoo, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1x8. (Email: shi-joon.yoo{at}sickkids.ca).

Pulmonary vein pathologies often present a diagnostic challenge. Among the different imaging modalities used for the evaluation of pulmonary veins, magnetic resonance is the most comprehensive in assessing anatomy and pathophysiology at the same time. Bright blood cine sequences and contrast-enhanced magnetic resonance angiography outline the course and connections of the pulmonary veins. Phase-contrast velocity mapping measures flow patterns, velocities, and volumes throughout the pulmonary circulation. This paper reviews contemporary utilization of magnetic resonance in the evaluation of pulmonary venous abnormalities in children, based on our experience over the last 5 years and on that of other investigators. We summarize how magnetic resonance imaging enhances our understanding of pulmonary vein physiology and how it can influence the diagnostic approach to children and adults with a pulmonary venous pathology, and we discuss its limitations.

Abbreviations and Acronyms   AVM = arteriovenous malformation   CT = computed tomography   GRE = gradient refocused echo   MRA = (contrast-enhanced) magnetic resonance angiography   MRI = magnetic resonance imaging   PC MRI = phase-contrast (velocity mapping) magnetic resonance imaging   Qp/Qs = pulmonary-to-systemic blood flow ratio   SSFP = steady-state free precession   TR = repetition time   Tres = temporal resolution   3D = 3-dimensional   %HbO 2 = blood oxygen saturation

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