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
Department of Pediatrics
Department of Nuclear Medicine
|| 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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