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MRT zur Therapieplanung bei Patienten mit Vorhofseptumdefekt

MRI for therapy planning in patients with atrial septum defects

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Zusammenfassung

Zielsetzung

Ziel war es, die Wertigkeit eines kombinierten MRT-Protokolls aus Funktionsuntersuchung, Flussmessung und MR-Angiographie zur präoperativen oder -interventionellen Abklärung bei Patienten mit Vorhofseptumdefekt zu evaluieren.

Material und Methoden

Ingesamt wurden 56 Patienten mit Vorhofseptumdefekt aus einem Kollektiv von 65 Patienten mit Verdacht auf Vorhofseptumdefekt, die im MRT untersucht wurden, in die Studie eingeschlossen. Anhand der Funktionsaufnahmen wurde der Typ des Vorhofseptumdefekts identifiziert. Mit einer Phasenkontrastflussmessung wurde das Ausmaß des Links-rechts-Shunts quantifiziert und bei 24 Patienten mit der Oxymetrie im Herzkatheter verglichen. Mit Hilfe der kontrastverstärkten MR-Angiographie wurden die thorakalen Gefäße beurteilt, um vaskuläre Anomalien zu identifizieren, die dann mit intraoperativen Ergebnissen verglichen wurden.

Ergebnisse

Die Indikation zur operativen Versorgung wurde bei 16 Patienten gestellt, 8 Patienten wurden interventionell behandelt und bei 32 Patienten mit Vorhofseptumdefekt ergab sich ein niedriges Shuntvolumen, das keine operative oder interventionelle Behandlung erforderte. Die Diagnose von vaskulären Anomalien, ausnahmslos Lungenvenenfehlmündungen, korrelierten in allen Fällen mit den intraoperativen Befunden, ebenso die Lokalisation der behandlungsbedürftigen Vorhofseptumdefekte mit den intraoperativen Ergebnissen und der präinterventionellen Untersuchung im Herzkatheterlabor. Die Ergebnisse der Shuntquantifizierung zeigte eine gute Korrelation mit den Ergebnissen der invasiven Oxymetrie (r=0,91, p <0,0001).

Schlussfolgerung

Das kombinierte MRT-Protokoll aus Cineaufnahmen, Phasenkontrastflussmessungen und kontrastverstärkter MR-Angiographie besitzt eine hohe diagnostische Genauigkeit bei der präoperativen Abklärung von Patienten mit Vorhofseptumdefekten.

Abstract

Purpose

The aim of this study was to determine the value of a combined magnetic resonance imaging (MRI) protocol including steady-state free precession (SSFP) imaging, phase-contrast measurements and contrast-enhanced MR angiography (CE-MRA) for presurgical or preinterventional diagnostic imaging in patients with suspected atrial septum defects.

Material and methods

Out of 65 MRI studies of patients with suspected atrial septum defects, 56 patients were included in the study. The atrial septum defects were identified on cine images. Velocity encoded flow measurements were used to determine shunt volumes, which were compared with invasive oxymetry in 24 patients. Contrast-enhanced MRI was used to assess the thoracic vessels in order to detect vascular anomalies. The findings were compared with the intraoperative results.

Results

A total of 24 patients with high shunt volumes were treated either surgically (16 patients) or interventionally (8 patients) and 32 patients with low shunt volumes did not require surgical or interventional treatment. The vascular anomaly, which in all cases was anomalous pulmonary venous return, was confirmed by the intraoperative findings. The type and location of atrial septal defects which required treatment, were confirmed intraoperatively or during the intervention. The results of shunt quantification by MRI showed a good correlation with the results of invasive oximetry (r=0.91, p <0.0001).

Conclusion

A combined MRI protocol including cine SSFP images, velocity-encoded flow measurements and CE-MRA is an accurate method for preoperative and preinterventional evaluation of atrial septum defects.

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Authors and Affiliations

  1. Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    A. Huber & E. Rummeny

  2. Institut für klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    M. Prompona, M. Reiser & D. Theisen

  3. Klinik und Poliklinik für Kinderkardiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    R. Kozlik-Feldmann

  4. Medizinische Klinik I, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    O. Mühling

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  1. A. Huber
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  2. M. Prompona
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  3. R. Kozlik-Feldmann
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  4. O. Mühling
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  5. E. Rummeny
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  6. M. Reiser
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  7. D. Theisen
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Correspondence to A. Huber.

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Huber, A., Prompona, M., Kozlik-Feldmann, R. et al. MRT zur Therapieplanung bei Patienten mit Vorhofseptumdefekt. Radiologe 51, 31–37 (2011). https://doi.org/10.1007/s00117-010-1998-5

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  • DOI: https://doi.org/10.1007/s00117-010-1998-5

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