Advertisement

European Radiology

, Volume 15, Issue 8, pp 1575–1580 | Cite as

Assessment of hemodynamic changes in the systemic and pulmonary arterial circulation in patients with cystic fibrosis using phase-contrast MRI

  • Sebastian LeyEmail author
  • Michael Puderbach
  • Christian Fink
  • Monika Eichinger
  • Christian Plathow
  • Susanne Teiner
  • Matthias Wiebel
  • Frank-Michael Müller
  • Hans-Ulrich Kauczor
Chest

Abstract

Cystic fibrosis (CF) leads to disabling lung disease and pulmonary hypertension (PH). The goal of this study was to assess the hemodynamics in the systemic and pulmonary arterial circulation of patients with CF using MRI. Ten patients with CF and 15 healthy volunteers were examined (1.5-T MRI). Phase-contrast flow measurements were assessed in the ascending aorta, pulmonary trunc, and the left and right pulmonary arteries (PA), resulting in the following parameters: peak velocity (PV) (centimeters per second) velocity rise gradient (VRG), time to PV (milliseconds), and the average area (centimeters squared). The blood flow ratio between the right and left lungs and the bronchosystemic shunt were calculated. For the ascending aorta and pulmonary trunc no parameter was significantly different between both populations. In the right PA a significantly lower PV (p=0.001) and VRG (p=0.02) was found. In the left PA there was a significantly (p=0.007) lower PV but no significant (p=0.07) difference between the VRG. The areas of the right (p=0.08) and left (p=0.5) PA were not significantly enlarged. For the volunteers a linear increase of PV in both PA was found with age, while it decreased in patients with CF. The blood flow distribution (right/left lung) showed no significant (p=0.7) difference between the groups. There was a significantly (p<0.001) higher bronchosystemic shunt volume in patients with CF (1.3 l/min) than in volunteers (0.1 l/min). Magnetic resonance based flow measurements in the right and left PA showed first indications for early development of PH. The significant increase in bronchosystemic shunt volume might be indicative fo the extent of parenchymal changes.

Keywords

Cystic fibrosis Magnetic resonance imaging Flow Bronchosystemic shunt 

Notes

Acknowledgement

This work was supported by the DFG (FOR 474).

References

  1. 1.
    Di Sant’Agnese PA, Talamo RC (1967) Pathogenesis and physiopathology of cystic fibrosis of the pancreas. Fibrocystic disease of the pancreas (Mucoviscidosis). N Engl J Med 277:1287–1294Google Scholar
  2. 2.
    Fraser KL, Tullis DE, Sasson Z, Hyland RH, Thornley KS, Hanly PJ (1999) Pulmonary hypertension and cardiac function in adult cystic fibrosis: role of hypoxemia. Chest 115:1321–1328Google Scholar
  3. 3.
    Elborn JS, Shale DJ, Britton JR (1991) Cystic fibrosis: current survival and population estimates to the year 2000. Thorax 46:881–885Google Scholar
  4. 4.
    Stern RC, Borkat G, Hirschfeld SS, Boat TF, Matthews LW, Liebman J, Doershuk CF (1980) Heart failure in cystic fibrosis. Treatment and prognosis of cor pulmonale with failure of the right side of the heart. Am J Dis Child 134:267–272Google Scholar
  5. 5.
    Francis PW, Muller NL, Gurwitz D, Milligan DW, Levison H, Bryan AC (1980) Hemoglobin desaturation: its occurrence during sleep in patients with cystic fibrosis. Am J Dis Child 134:734–740Google Scholar
  6. 6.
    Glanville AR, Estenne M (2003) Indications, patient selection and timing of referral for lung transplantation. Eur Respir J 22:845–852Google Scholar
  7. 7.
    Thalhammer A, Jacobi V, Balzer J, Straub R, Vogl TJ (2002) Bronchial artery embolization for therapy of pulmonary bleeding in patients with cystic fibrosis. Fortschr Röntgenstr 174:588–592Google Scholar
  8. 8.
    Kitabatake A, Inoue M, Asao M (1983) Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation 68:302–309Google Scholar
  9. 9.
    Nauser TD, Stites SW (2001) Diagnosis and treatment of pulmonary hypertension. Am Fam Phys 63:1789–1798Google Scholar
  10. 10.
    Bright-Thomas RJ, Webb AK (2002) The heart in cystic fibrosis. J R Soc Med 95(Suppl 41):2–10Google Scholar
  11. 11.
    Lotz J, Meier C, Leppert A, Galanski M (2002) Cardiovascular flow measurement with phase-contrast MR imaging: basic facts and implementation. Radiographics 22:651–671Google Scholar
  12. 12.
    Ley S, Kreitner K-F, Morgenstern I, Thelen M, Kauczor H-U (2002) Bronchopulmonary shunts in patients with chronic thromboembolic pulmonary hypertension: evaluation by helical CT and MR imaging. Am J Roentgenol 179:1209–1215PubMedGoogle Scholar
  13. 13.
    Bossone E, Avelar E, Bach DS, Gillespie B, Rubenfire M, Armstrong WF (2000) Diagnostic value of resting tricuspid regurgitation velocity and right ventricular ejection flow parameters for the detection of exercise induced pulmonary arterial hypertension. Int J Card Imaging 16:429–436Google Scholar
  14. 14.
    Caputo GR, Kondo C, Masui T, Geraci SJ, Foster E, O’Sullivan MM, Higgins CB (1991) Right and left lung perfusion: in vitro and in vivo validation with oblique-angle, velocity-encoded cine MR imaging. Radiology 180:693–698PubMedGoogle Scholar
  15. 15.
    Rominger MB, Dinkel HP, Bachmann GF (2002) Comparison between fast MR flow quantification in breathhold technique in ascending aorta and pulmonary trunc with right and left ventricular cine-MRI for the assessment of stroke volumes in healthy volunteers. Fortschr Röntgenstr 174:196–201Google Scholar
  16. 16.
    van den Hout RJ, Lamb HJ, van den Aardweg JG, Schot R, Steendijk P, van der Wall EE, Bax JJ, de Roos A (2003) Real-time MR imaging of aortic flow: influence of breathing on left ventricular stroke volume in chronic obstructive pulmonary disease. Radiology 229:513–519Google Scholar
  17. 17.
    Chatzimavroudis GP, Zhang H, Halliburton SS, Moore JR, Simonetti OP, Schvartzman PR, Stillman AE, White RD (2003) Clinical blood flow quantification with segmented k-space magnetic resonance phase velocity mapping. J Magn Reson Imaging 17:65–71Google Scholar
  18. 18.
    Abolmaali ND, Schmitt JM, Rosewich M, Posselt H-G, Smaczny C, Bretz F, Wolf T, Vogl TJ (2004) Detection of pulmonary hypertension in patients with cystic fibrosis (CF) using MRI European Congress of RadiologyB-617Google Scholar
  19. 19.
    Dabestani A, Mahan G, Gardin JM, Takenaka K, Burn C, Allfie A, Henry WL (1987) Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol 59:662–668Google Scholar
  20. 20.
    Boxt LM (1996) MR imaging of pulmonary hypertension and right ventricular dysfunction. Magn Reson Imaging Clin N Am 4:307–325Google Scholar
  21. 21.
    Laffon E, Bernard V, Montaudon M, Marthan R, Barat JL, Laurent F (2001) Tuning of pulmonary arterial circulation evidenced by MR phase mapping in healthy volunteers. J Appl Physiol 90:469–474Google Scholar
  22. 22.
    Roberts HC, Kauczor H-U, Schweden F, Thelen M (1997) Spiral CT of pulmonary hypertension and chronic thromboembolism. J Thorac Imaging 12:118–127Google Scholar
  23. 23.
    Kauczor H-U, Schwickert HC, Mayer E, Schweden F, Schild HH, Thelen M (1994) Spiral CT of bronchial arteries in chronic thromboembolism. J Comput Assist Tomogr 18:855–861Google Scholar
  24. 24.
    Vizza CD, Lynch JP, Ochoa LL, Richardson G, Trulock EP (1998) Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest 113:576–583Google Scholar
  25. 25.
    Puderbach MU, Fink C, Ley S, Plathow C, Schmähl A, Kauczor H-U (2004) Imaging of chronic lung diseases using morphological and functional MRI European Congress of RadiologyC-290Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Sebastian Ley
    • 1
    • 2
    Email author
  • Michael Puderbach
    • 1
  • Christian Fink
    • 1
  • Monika Eichinger
    • 1
    • 2
  • Christian Plathow
    • 1
  • Susanne Teiner
    • 3
  • Matthias Wiebel
    • 4
  • Frank-Michael Müller
    • 5
  • Hans-Ulrich Kauczor
    • 1
  1. 1.Department of Radiology (E010)DKFZHeidelbergGermany
  2. 2.Department of Radiology, University Hospital MainzJohannes Gutenberg UniversityMainzGermany
  3. 3.Department of Pediatric RadiologyUniversity of HeidelbergHeidelbergGermany
  4. 4.Department of PulmonologyThoraxklinik am UniversitätsklinikumHeidelbergGermany
  5. 5.Department of Pediatric Pulmonology, Cystic Fibrosis Center & Infectious Diseases, Children’s HospitalUniversity of HeidelbergHeidelbergGermany

Personalised recommendations