Influence of Pulmonary Regurgitation Inequality on Differential Perfusion of the Lungs in Tetralogy of Fallot After RepairA Phase-Contrast Magnetic Resonance Imaging and Perfusion Scintigraphy Study
Ming-Ting Wu, MD*, ,*,
Yi-Luan Huang, MD*,,
Kai-Sheng Hsieh, MD ,
Ju-Tung Huang, MD*,,
Nan-Jing Peng, MD*, ,
Jun-Yen Pan, MD*,||,
Jer-Shyung Huang*,,¶ and
Tsung-Lung Yang*,,¶
* Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
|| Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
¶ Shu Zen College of Medicine and Management, Kaohsiung, Taiwan.
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Figure 1 Example Case
Example case showing differential lung perfusion estimated by phase-contrast magnetic resonance imaging (MRI) and perfusion scintigraphy. (A) Left, magnitude image of right pulmonary artery (RPA) (arrow) at cross-sectional plane; middle, magnitude image of left pulmonary artery (LPA) (arrow); right, phase-contrast image of LPA at systole with forward flow (upper), encoded white color (arrowhead), and at diastole with backward flow (lower), encoded black color (arrowhead). (B) Flow volume-time curve profile of left and right pulmonary arteries. S, D, correspond to phase-contrast images at systole and diastole in (A), respectively. (C)
99mTc-labeled macroaggregates of albumin perfusion scintigraphy, posterior-anterior view. The L% was 32%. Note that estimation by net flow volume ratio resulted in an underestimation of left lung perfusion as much as –19%. (D) Bar chart showing the phase-contrast MRI measurements of absolute flow volume and differential perfusion of left lung (L%) and right lung (R%) calculated on the basis of forward flow, backward flow, and net flow volume, respectively. AA = ascending aortal; DA = descending aorta; LA = left atrium; LV = left ventricle; PA = pulmonary artery; RF = regurgitation fraction = backward flow volume divided by forward flow volume; RR = cardiac beat-to-beat interval.0
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Figure 2 Discrepancy of L% Measurement
Bland-Altman plots of differential perfusion of the left lung (L%) measured by phase-contrast magnetic resonance imaging flow versus perfusion scintigraphy (PS). FFV = forward flow volume; MR = magnetic resonance; NFV = net flow volume.
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Figure 3 Effect of Regurgitation Fraction on Discrepancy of L% Measurement
Scatterplot of regurgitation fraction of left pulmonary artery versus discrepancy between L% calculated by phase-contrast magnetic resonance imaging (PC-MRI) flow and PS. Abbreviations as in Figure 2.
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Figure 4 Distribution of Regurgitation Fraction in the Vessels In-Pair
Distribution of regurgitation fraction in the 4 vessels in pair of the 16 cases receiving additional lower-lung phase-contrast magnetic resonance (MR) imaging scan. LDPA = left descending pulmonary artery; LPA = left pulmonary artery; RDPA = right descending pulmonary artery; RPA = right pulmonary artery.
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