Evaluation of intracardiac shunts with cardiac magnetic resonance
- Patrick M. Colletti MD
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Intracardiac shunts including atrial septal defect, ventricular septal defect, endocardial cushion defects, and surgical baffles may be identified, localized, and quantified using cardiac MRI methods. Both dark-blood and bright-blood techniques are helpful to identify anatomy. Contrast enhancement is especially useful for identifying associated vascular anomalies. Dynamic first-pass contrast agent signal-time studies may demonstrate rapid recirculation and shunting. Volumetric and phase contrast cine methods are useful to quantify flow. Pulmonary to systemic (Qp/Qs) flow ratios may be calculated noninvasively by comparing the pulmonary artery flow to the aortic flow measurement.
- Miller HC, Brown DJ, Miller GA: Comparison of formulae used to estimate oxygen saturation of mixed venous blood from caval samples. Br Heart J 1974, 36:446–451.
- Boehrer JD, Lange RA, Willard JE, et al.: Advantages and limitations of methods to detect, localize and quantitate intracardiac left-to-right shunting. Am Heart J 1992, 124:448–455. CrossRef
- Baker EJ, Ellam SV, Lorber A, et al.: Superiority of radionuclide over oximetric measurement of left to right shunts. Br Heart J 1985, 53:535–540. In children with suspected left to right shunts, the Qp/Qs ratio measured by first-pass radionuclide angiography analyzed by the method of gamma variate fit is more precise and less invasive than oximetry.
- Mohiaddin RH, Underwood R, Romeira L, et al.: Comparison between cine magnetic resonance velocity mapping and first-pass radionuclide angiocardiography for quantitating intracardiac shunts. Am J Cardiol 1995, 75:529–532. CrossRef
- Arheden H, Holmqvist C, Thilen U, et al.: Left-to-right cardiac shunts: comparison of measurements obtained with mr velocity mapping and with radionuclide angiography. Radiology 1999, 211:453–458.
- Boxt LM, Rozenshtein A: MR imaging of congenital heart disease. Magn Reson Imaging Clin N Am 2003, 11:27–48. CrossRef
- Wang ZJ, Reddy GP, Gotway MB, et al.: Cardiovascular shunts: MR imaging evaluation. Radiographics 2003, 23:S181-S194. Excellent CMR images of cardiac shunts are provided. CrossRef
- Greil GF, Powell AJ, Gildein HP, Geva T: Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies. J Am Coll Cardiol 2002, 39:335–341. Gadolinium-enhanced 3D MRA rapidly and accurately demonstrates a wide spectrum of pulmonary and systemic venous anomalies. CrossRef
- Francois CJ, Shors SM, Bonow RO, Finn JP, et al.: Analysis of cardiopulmonary transit times at contrast material-enhanced MR imaging in patients with heart disease. Radiology 2003, 227:447–452. CrossRef
- Shors SM, Cotts WG, Pavlovic-Surjancev B, et al.: Heart failure: evaluation of cardiopulmonary transit times with timeresolved MR angiography. Radiology 2003, 229:743–748. CrossRef
- Firmin DN, Nayler GL, Klipstein RH, et al.: In vivo validation of MR velocity imaging. J Comput Assist Tomogr 1987, 11:751–756. Calculations of LV stroke volume obtained by summing the areas of multiple contiguous transverse MR slices in systole and diastole using a spin-echo sequence have been compared in 10 healthy volunteers with the stroke output derived from velocity maps in the ascending aorta using a field even-echo rephasing sequence. The results gave a correlation coefficient of 0.97 (P < 0.001) and a standard error of estimate of 3.2 mL (SD = 10.1 mL). CrossRef
- Rominger MB, Kluge A, Dinkel HP, Bachmann GF: [Comparison between biventricular cine MRI and MR flow quantification in ascending aorta and pulmonary outflow tract for the assessment of intracardiac shunt volumes]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2002, 174:1380–1386. PC-cine flow measurements in the aorta and pulmonary artery are more accurate than biventricular cine MRI for the assessment of Qp/Qs ratios. Qp and Qs combined with biventricular cine CMR enables the quantification of hemodynamic significant shunts, higher-grade valvular regurgitation, and biventricular global systolic function with a single examination. CrossRef
- Brenner LD, Caputo GR, Mostbeck G, et al.: Quantification of left to right atrial shunts with velocity-encoded cine nuclear magnetic resonance imaging. J Am Coll Cardiol 1992, 20:1246–1250. VENC PC-cine flow MR-quantified stroke flow in the aorta and main pulmonary artery and the Qp/Qs were calculated and compared with oximetric data derived from cardiac catheterization and from CMR volumetric data. VENC PC-cine flow MR is an accurate and reproducible method for measuring Qp/Qs in left to right shunts. Because it is completely noninvasive, it can be used to monitor shunt volume over time. CrossRef
- Wolf RL, Ehman RL, Riederer SJ, et al.: Analysis of systematic and random error in mr volumetric flow measurements. Magn Reson Med 1993, 30:82–91. CrossRef
- Debatin JF, Leung DA, Wildermuth S et al.: Flow quantitation with echo-planar phase-contrast velocity mapping: in vitro and in vivo evaluation. J Magn Reson Imaging 1995, 5:656–662. CrossRef
- Hundley WG, Li HF, Lange RA, et al.: Assessment of left-to-right intracardiac shunting by velocity-encoded, phase-difference magnetic resonance imaging: a comparison with oximetric and indicator dilution techniques. Circulation 1995, 91:2955–2960. In comparison to oximetry and indocyanine green, VENC PC-cine flow MR correctly identified 12 patients with a Qp/Qs of less than 1.5 (nine without intracardiac shunting and three with small shunts) and nine patients with a Qp/Qs of at least 1.5 (six with ASD, one with VSD, one with PDA, and one with both ASD and PDA).
- Arheden H, Holmqvist C, Thilen U, et al.: Left-to-right cardiac shunts: comparison of measurements obtained with MR velocity mapping and with radionuclide angiography. Radiology 1999, 211:453–458. QP/QS by radionuclide angiography was 14% ± 13%, higher than at PC-cine MR velocity mapping. Interobserver variability was four times higher for radionuclide angiography compared with MR velocity mapping. The difference between repeated MR flow measurements in the same vessel was −1% ± 5% (n = 36).
- Petersen SE, Voigtlander T, Kreitner KF, et al.: Quantification of shunt volumes in congenital heart diseases using a breath-hold MR phase contrast technique-comparison with oximetry. Int J Cardiovasc Imaging 2002, 18:53–60. Using a short acquisition time with breath-hold PC-cine flow MR, velocity data correlate well (r = 0.91, P < 0.001) with invasively measured Qp/Qs. Cardiac shunt volumes can be measured reliably. CrossRef
- Powell AJ, Geva T: Blood flow measurement by MRI in congenital heart disease. Pediatr Cardiol 2000, 21:47–58. CrossRef
- Rebergen SA, van der Wall EE, Helbing WA, et al.: Quantification of pulmonary and systemic blood flow by magnetic resonance velocity mapping in the assessment of atrial-level shunts. Int J Card Imaging 1996, 12:143–152. PC-cine flow MR velocity mapping offers an accurate method to measure aortic and pulmonary artery volume flow in the evaluation of atrial-level shunts, in order to establish a definite diagnosis and/or to quantify the Qp/Qs ratio. CrossRef
- Taylor AM, Stables RH, Poole-Wilson PA, Pennell DJ: Definitive clinical assessment of atrial septal defect by magnetic resonance imaging. J Cardiovasc Magn Reson 1999, 1:43–47. PC-cine flow MR is an accurate technique to quantify pulsatile blood flow at a specific location, and to noninvasively calculate Qp and Qs under normal flow conditions.
- Powell AJ, Maier SE, Chung T, Geva T: Phase-velocity cine magnetic resonance imaging measurement of pulsatile blood flow in children and young adults: in vitro and in vivo validation. Pediatr Cardiol 2000, 21:104–110. CrossRef
- Korperich H, Gieseke J, Barth P, et al.: Flow volume and shunt quantification in pediatric congenital heart disease by real-time magnetic resonance velocity mapping: a validation study. Circulation 2004, 109:1987–1793. CrossRef
- Rebergen SA, van der Wall EE, Doornbos J, et al.: Magnetic resonance measurement of velocity and flow: technique, validation, and cardiovascular applications. Am Heart J 1993, 126:1439–1456. PC-cine flow MR quantitation uses the phase of the MR signal to reconstruct images at frequent intervals throughout the cardiac cycle. From this, 2D flow maps, velocity, and volume flow data can be obtained. MR velocity mapping may be of considerable value when Doppler echocardiography results are unsatisfactory or equivocal. CrossRef
- Mohaiddin RH: Assessment of intracardiac shunt by magnetic resonance imaging. Int J Card Imaging 1996, 12:215–217. Qp/Qs ratios were calculated from both cine MR stroke volume data and PC-cine flow MR velocity-mapping flow data in seven patients with ASD. Measurements of LV and RV stroke corresponded closely with those of aortic (r = 0.98) and pulmonary flow (r = 0.99) respectively, and Qp/Qs flow ratios agreed with stroke volume ratios (r = 0.92). CrossRef
- Beerbaum P, Korperich H, Gieseke J, et al.: Rapid left-to-right shunt quantification in children by phase-contrast magnetic resonance imaging combined with sensitivity encoding (SENSE). Circulation 2003, 108:1355–1361. PC-cine flow MR quantitation may be combined with parallel acquisition to achieve a substantive reduction of scanning time. In children with left to right shunt, Qp/Qs quantification by PC-cine flow MR with a parallel factor of 3 in is possible in under 60 seconds. Use of higher in-plane resolution did not improve measurement results. CrossRef
- Kalden P, Kreitner KF, Voigtlander T, et al.: [Flow quantification of intracardiac shunt volumes using MR phase contrast technique in the breath holding phase] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1998, 169:378–382. In four healthy individuals breath-hold, PC-cine flow CMR, VENC = 250 cm/sec, yielded a Qp/Qs ratio of 0.96 ± 0.15. In 10 patients with shunt defects (six ASD/three VSD/one PDA), CMR gave a Qp/Qs ratio of 2.09 ± 0.67. Calculated shunt sizes were 47.05% ± 17.45%. PC-flow CMR data showed a strong correlation (r = 0.87) with invasive oximetry. CrossRef
- Pruessmann K, Weiger M, Scheidegger M, Boesiger P: SENSE: sensitivity encoding for fast MRI. Magn Reson Med 1999, 42:952–962. CrossRef
- Pruessmann KP, Weiger M, Boesiger P: Sensitivity encoded cardiac MRI. J Cardiovasc Magn Reson 2001, 3:1–9. Cardiac real-time parallel acquisition is demonstrated in several modes, including real-time imaging of three parallel slices at a rate of 25 triple frames per second. CrossRef
- Nayak KS, J Pauly M, Kerr AB, et al.: Real-time color flow MRI. Magn Reson Med 2000, 43:251–258. CrossRef
- Nayak KS, Hu BS, and Nishimura DG: Rapid quantitation of high-speed flow jets. Magn Reson Med 2003, 50:366–372. CrossRef
- Holmvang G, Palacios IF, Vlahakes GJ, et al.: Imaging and sizing of atrial septal defects by magnetic resonance. Circulation 1995, 92:3473–3480. Because septal thinning adjacent to a secundum ASD may appear to be part of the defect, CMR measurements overestimated major diameter and area of secundum ASDs by 48% and 125%, respectively. PC-cine flow MR images acquired in the plane of an ASD defined the defect size and shape with sufficient accuracy to permit stratification of patients to closure of the defect by catheter-based techniques versus surgery.
- Lange A, Walayat M, Turnbull CM, et al.: Assessment of atrial septal defect morphology by transthoracic three dimensional echocardiography using standard grey scale and Doppler myocardial imaging techniques: comparison with magnetic resonance imaging and intraoperative findings. Heart 1997, 78:382–389. In 34 adult patients, maximum secundum ASD dimensions were measured and compared with surgery. Doppler myocardial imaging was a more effective technique than standard grey scale echocardiography in describing morphology. This correlated well with gated VENC PC-cine flow MR (maximum velocity sensitivity of 120 cm/sec) with the imaging plane parallel to, and contiguous with, the right atrial side of the interatrial septum, to provide an en face view of the defect.
- Beerbaum P, Korperich H, Barth P, et al.: Noninvasive quantification of left-to-right shunt in pediatric patients: phase-contrast cine magnetic resonance imaging compared with invasive oximetry. Circulation 2001, 103:2476–2482. Blood flow through a secundum atrial septal defect as assessed PC-cine flow MR (n = 24) overestimated the shunt compared difference between pulmonary and aortic flows. The mean between three repeated PC-cine flow MR measurements in location was 5.3% (SD ± 4.0%, n = 522), demonstrating good Interobserver variability was low. The accuracy of PC-cine was confirmed by in vitro experiments.
- Beerbaum P, Körperich H, Esdorn H, et al.: Atrial septal in pediatric patients: noninvasive sizing with cardiovascular MR imaging. Radiology 2003, 228:361–369. In children with ASD and inconclusive transthoracic echocardiography results, MR imaging can enable determination of defect rim distances to adjacent structures, and venous connections. CrossRef
- Evaluation of intracardiac shunts with cardiac magnetic resonance
Current Cardiology Reports
Volume 7, Issue 1 , pp 52-58
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links
- Author Affiliations
- 1. LAC+USC Imaging Science Center, University of Southern California Keck School of Medicine, 1744 Zonal Avenue, 90033, Los Angeles, CA, USA