European Radiology

, Volume 17, Issue 1, pp 151–162 | Cite as

Preoperative assessment and follow-up of congenital abnormalities of the pulmonary arteries using CT and MRI

  • Sebastian LeyEmail author
  • Julia Zaporozhan
  • Raoul Arnold
  • Joachim Eichhorn
  • Jens-Peter Schenk
  • Herbert Ulmer
  • Karl-Friedrich Kreitner
  • Hans-Ulrich Kauczor


Congenital heart disease (CHD), including complex anomalies of the pulmonary arteries, are now earlier diagnosed and treated. Due to improvements in interventional and surgical therapy, the number of patients with the need for follow-up examinations is increasing. Pre- and postinterventional imaging should be done as gently as possible, avoiding invasive techniques if possible. With the technical improvement of multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI), both techniques are increasingly used for noninvasive assessment of the pulmonary vasculature in children with CHD. Knowledge of the most common diseases affecting the pulmonary vasculature and the kind of surgical and interventional procedures is essential for optimal imaging planning. This is especially important because interventions can be positively influenced by high-quality imaging. Therefore, the most common diseases and procedures are described and imaging modality of choice and important image findings are discussed.


Pulmonary arteries MDCT MRI Paediatric 


  1. 1.
    Hoffman JI (1995) Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol 16:155–165PubMedCrossRefGoogle Scholar
  2. 2.
    Bernstein D (2004) Congenital heart disease nelson textbook of pediatrics, pp 1499–1554Google Scholar
  3. 3.
    Perloff JK (1991) Congenital heart disease in adults. A new cardiovascular subspecialty. Circulation 84:1881–1890PubMedGoogle Scholar
  4. 4.
    Eichhorn J, Fink C, Delorme S, Ulmer H (2004) Rings, slings and other vascular abnormalities. Ultrafast computed tomography and magnetic resonance angiography in pediatric cardiology. Z Kardiol 93:201–208PubMedCrossRefGoogle Scholar
  5. 5.
    Maintz D, Juergens KU, Wichter T, Grude M, Heindel W, Fischbach R (2003) Imaging of coronary artery stents using multislice computed tomography:in vitro evaluation. Eur Radiol 13:830–835PubMedGoogle Scholar
  6. 6.
    Goo HW, Park IS, Ko JK, Kim YH, Seo DM, Yun TJ, Park JJ, Yoon CH (2003) CT of congenital heart disease:normal anatomy and typical pathologic conditions. Radiographics 23(Spec No):S147–S165PubMedCrossRefGoogle Scholar
  7. 7.
    Keats TE, Sistrom C (2001) Atlas of radiologic measurementGoogle Scholar
  8. 8.
    Long FR, Castile RG, Brody AS, Hogan MJ, Flucke RL, Filbrun DA, McCoy KS (1999) Lungs in infants and young children:improved thin-section CT with a noninvasive controlled-ventilation technique-initial experience. Radiology 212:588–593PubMedGoogle Scholar
  9. 9.
    Raman SV, Cook SC, McCarthy B, Ferketich AK (2005) Usefulness of multidetector row computed tomography to quantify right ventricular size and function in adults with either tetralogy of Fallot or transposition of the great arteries. Am J Cardiol 95:683–686PubMedCrossRefGoogle Scholar
  10. 10.
    Greuter M, Lips J, van Ooijen P, Oudkerk M (2005) Comparative study of coronary motion artefacts in four multidetector ECG -gated computed tomography units with an anthropomorphic moving heart phantom. Eur Radiol 15:E3CrossRefGoogle Scholar
  11. 11.
    Eichhorn JG, Fink C, Long F, Arnold R, Ley S, Ulmer H, Kauczor HU (2005) [Multidetector CT of Congenital Vascular Anomalies and Associated Complications in Newborns and Infants.]. Fortschr Röntgenstr 177:1366–1372CrossRefGoogle Scholar
  12. 12.
    Fiore AC, Brown JW, Weber TR, Turrentine MW (2005) Surgical treatment of pulmonary artery sling and tracheal stenosis. Ann Thorac Surg 79:38–46; discussion 38–46PubMedCrossRefGoogle Scholar
  13. 13.
    Murai S, Hamada S, Yamamoto S, Khankan AA, Sumikawa H, Inoue A, Tsubamoto M, Honda O, Tomiyama N, Johkoh T, Nakamura H (2004) Evaluation of major aortopulmonary collateral arteries (MAPCAs) using three-dimensional CT angiography:two case reports. Radiat Med 22:186–189PubMedGoogle Scholar
  14. 14.
    Lee EY, Siegel MJ, Hildebolt CF, Gutierrez FR, Bhalla S, Fallah JH (2004) MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults:comparison of axial, multiplanar, and 3D images. AJR Am J Roentgenol 182:777–784PubMedGoogle Scholar
  15. 15.
    Vock P (2005) CT dose reduction in children. Eur Radiol 15:2330–2340PubMedCrossRefGoogle Scholar
  16. 16.
    Eichhorn J, Long FR, Hill SL, O’Donovan J, Chisolm JL, Fernandez SA (2006) Assessment of in-stent stenosis in small children with congenital heart disease using multi-detector computed tomography: a validation study. Catheter Cardio Interv 64 (in press)Google Scholar
  17. 17.
    Bacher K, Bogaert E, Lapere R, De Wolf D, Thierens H (2005) Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 111:83–89PubMedCrossRefGoogle Scholar
  18. 18.
    Naganawa S, Kawai H, Fukatsu H, Ishigaki T, Komada T, Maruyama K, Takizawa O (2004) High-speed imaging at 3 Tesla:a technical and clinical review with an emphasis on whole-brain 3D imaging. Magn Reson Med Sci 3:177–187PubMedCrossRefGoogle Scholar
  19. 19.
    Gilmore JH, Zhai G, Wilber K, Smith JK, Lin W, Gerig G (2004) 3 Tesla magnetic resonance imaging of the brain in newborns. Psychiatry Res 132:81–85PubMedCrossRefGoogle Scholar
  20. 20.
    Weiss F, Habermann CR, Lilje C, Nimz M, Rasek V, Dallmeyer J, Stork A, Graessner J, Weil J, Adam G (2005) [MRI of pulmonary arteries in follow-up after Arterial-Switch-Operation (ASO) for transposition of great arteries (d-TGA).]. Fortschr Röntgenstr 177:849–855CrossRefGoogle Scholar
  21. 21.
    Holmqvist C, Hochbergs P, Bjorkhem G, Brockstedt S, Laurin S (2001) Pre-operative evaluation with MR in tetralogy of fallot and pulmonary atresia with ventricular septal defect. Acta Radiol 42:63–69PubMedCrossRefGoogle Scholar
  22. 22.
    Fink C, Eichhorn J, Kiessling F, Bock M, Delorme S (2003) [Time-resolved multiphasic 3D MR angiography in the diagnosis of the pulmonary vascular system in children]. Fortschr Röntgenstr 175:929–935CrossRefGoogle Scholar
  23. 23.
    Macgowan CK, Al-Kwifi O, Varodayan F, Yoo SJ, Wright GA, Kellenberger CJ (2005) Optimization of 3D contrast-enhanced pulmonary magnetic resonance angiography in pediatric patients with congenital heart disease. Magn Reson Med 54:207–212PubMedCrossRefGoogle Scholar
  24. 24.
    Fries P, Altmeyer K, Seidel R, Massmann A, Kirchin MA, Schneider G (2005) Dynamic contrast enhanced MRA in pediatric patients after application of Gd-BOPTA. Eur Radiol 15:E8Google Scholar
  25. 25.
    Grist TM, Thornton FJ (2005) Magnetic resonance angiography in children:technique, indications, and imaging findings. Pediatr Radiol 35:26–39PubMedCrossRefGoogle Scholar
  26. 26.
    Boll DT, Lewin JS, Young P, Siwik ES, Gilkeson RC (2005) Perfusion abnormalities in congenital and neoplastic pulmonary disease:comparison of MR perfusion and multislice CT imaging. Eur Radiol 15:1978–1986PubMedCrossRefGoogle Scholar
  27. 27.
    Ley S, Fink C, Zaporozhan J, Borst MM, Meyer FJ, Puderbach M, Eichinger M, Plathow C, Grunig E, Kreitner KF, Kauczor HU (2005) Value of high spatial and high temporal resolution magnetic resonance angiography for differentiation between idiopathic and thromboembolic pulmonary hypertension:initial results. Eur Radiol 15:2256–2263PubMedCrossRefGoogle Scholar
  28. 28.
    Biederer J, Both M, Graessner J, Liess C, Jakob P, Reuter M, Heller M (2003) Lung morphology: fast MR imaging assessment with a volumetric interpolated breath-hold technique:initial experience with patients. Radiology 226:242–249PubMedCrossRefGoogle Scholar
  29. 29.
    Jhooti P, Gatehouse PD, Keegan J, Bunce NH, Taylor AM, Firmin DN (2000) Phase ordering with automatic window selection (PAWS):a novel motion-resistant technique for 3D coronary imaging. Magn Reson Med 43:470–480PubMedCrossRefGoogle Scholar
  30. 30.
    Sorensen TS, Korperich H, Greil GF, Eichhorn J, Barth P, Meyer H, Pedersen EM, Beerbaum P (2004) Operator-independent isotropic three-dimensional magnetic resonance imaging for morphology in congenital heart disease:a validation study. Circulation 110:163–169PubMedCrossRefGoogle Scholar
  31. 31.
    Sorensen TS, Beerbaum P, Korperich H, Pedersen EM (2005) Three-dimensional, isotropic MRI:a unified approach to quantification and visualization in congenital heart disease. Int J Cardiovasc Imaging 21:283–292PubMedCrossRefGoogle Scholar
  32. 32.
    Greil GF, Kramer U, Dammann F, Schick F, Miller S, Claussen CD, Sieverding L (2005) Diagnosis of vascular rings and slings using an interleaved 3D double-slab FISP MR angiography technique. Pediatr Radiol 35:396–401PubMedCrossRefGoogle Scholar
  33. 33.
    Boechat MI, Ratib O, Williams PL, Gomes AS, Child JS, Allada V (2005) Cardiac MR imaging and MR angiography for assessment of complex tetralogy of Fallot and pulmonary atresia. Radiographics 25:1535–1546PubMedCrossRefGoogle Scholar
  34. 34.
    Roman KS, Kellenberger CJ, Farooq S, MacGowan CK, Gilday DL, Yoo SJ (2005) Comparative imaging of differential pulmonary blood flow in patients with congenital heart disease: magnetic resonance imaging versus lung perfusion scintigraphy. Pediatr Radiol 35:295–301PubMedCrossRefGoogle Scholar
  35. 35.
    Gatehouse PD, Keegan J, Crowe LA, Masood S, Mohiaddin RH, Kreitner KF, Firmin DN (2005) Applications of phase-contrast flow and velocity imaging in cardiovascular MRI. Eur Radiol 15:2172–2184PubMedCrossRefGoogle Scholar
  36. 36.
    Varaprasathan GA, Araoz PA, Higgins CB, Reddy GP (2002) Quantification of flow dynamics in congenital heart disease:applications of velocity-encoded cine MR imaging. Radiographics 22:895–905; discussion 905–896PubMedGoogle Scholar
  37. 37.
    Nakanishi T (2005) Cardiac catheterization is necessary before bidirectional Glenn and Fontan procedures in single ventricle physiology. Pediatr Cardiol 26:159–161PubMedCrossRefGoogle Scholar
  38. 38.
    Sequeiros RB, Ojala R, Kariniemi J, Perala J, Niinimaki J, Reinikainen H, Tervonen O (2005) MR-guided interventional procedures: a review. Acta Radiol 46:576–586PubMedCrossRefGoogle Scholar
  39. 39.
    Bock M, Umathum R, Zuehlsdorff S, Volz S, Fink C, Hallscheidt P, Zimmermann H, Nitz W, Semmler W (2006) Interventional magnetic resonance imaging:an alternative to image guidance with ionising radiation. Radiat Prot Dosimetry 117:74–78CrossRefGoogle Scholar
  40. 40.
    Rickers C, Seethamraju RT, Jerosch-Herold M, Wilke NM (2003) Magnetic resonance imaging guided cardiovascular interventions in congenital heart diseases. J Interv Cardiol 16:143–147PubMedGoogle Scholar
  41. 41.
    Krueger JJ, Ewert P, Yilmaz S, Gelernter D, Peters B, Pietzner K, Bornstedt A, Schnackenburg B, Abdul-Khaliq H, Fleck E, Nagel E, Berger F, Kuehne T (2006) Magnetic resonance imaging-guided balloon angioplasty of coarctation of the aorta: a pilot study. Circulation 113:1093–1100PubMedCrossRefGoogle Scholar
  42. 42.
    Bhat AH, Sahn DJ (2004) Congenital heart disease never goes away, even when it has been ‘reate’:the adult with congenital heart disease. Curr Opin Pediatr 16:500–507PubMedCrossRefGoogle Scholar
  43. 43.
    Blalock A, Taussig HB (1945) The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA 128:189–202Google Scholar
  44. 44.
    Duncan BW, Mee RB, Prieto LR, Rosenthal GL, Mesia CI, Qureshi A, Tucker OP, Rhodes JF, Latson LA (2003) Staged repair of tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg 126:694–702PubMedCrossRefGoogle Scholar
  45. 45.
    Konen E, Raviv-Zilka L, Cohen RA, Epelman M, Boger-Megiddo I, Bar-Ziv J, Hegesh J, Ofer A, Konen O, Katz M, Gayer G, Rozenman J (2003) Congenital pulmonary venolobar syndrome:spectrum of helical CT findings with emphasis on computerized reformatting. Radiographics 23:1175–1184PubMedCrossRefGoogle Scholar
  46. 46.
    Tchervenkov CI, Chedrawy EG, Korkola SJ (2002) Fontan operation for patients with severe distal pulmonary artery stenosis, atresia, or a single lung. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 5:68–75PubMedCrossRefGoogle Scholar
  47. 47.
    Gewillig M (2005) The Fontan circulation. Heart 91:839–846PubMedCrossRefGoogle Scholar
  48. 48.
    Jacobs ML, Pourmoghadam KK (2003) The hemi-Fontan operation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 6:90–97PubMedCrossRefGoogle Scholar
  49. 49.
    Ohye RG, Bove EL (2001) Advances in congenital heart surgery. Curr Opin Pediatr 13:473–481PubMedCrossRefGoogle Scholar
  50. 50.
    Jatene AD, Fontes VF, Paulista PP, Souza LC, Neger F, Galantier M, Sousa JE (1976) Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg 72:364–370PubMedGoogle Scholar
  51. 51.
    Losay J, Touchot A, Serraf A, Litvinova A, Lambert V, Piot JD, Lacour-Gayet F, Capderou A, Planche C (2001) Late outcome after arterial switch operation for transposition of the great arteries. Circulation 104:I121–126PubMedCrossRefGoogle Scholar
  52. 52.
    Gutberlet M, Boeckel T, Hosten N, Vogel M, Kuhne T, Oellinger H, Ehrenstein T, Venz S, Hetzer R, Bein G, Felix R (2000) Arterial switch procedure for D-transposition of the great arteries:quantitative midterm evaluation of hemodynamic changes with cine MR imaging and phase-shift velocity mapping-initial experience. Radiology 214:467–475PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Sebastian Ley
    • 1
    • 2
    Email author
  • Julia Zaporozhan
    • 2
  • Raoul Arnold
    • 3
    • 5
  • Joachim Eichhorn
    • 3
  • Jens-Peter Schenk
    • 1
  • Herbert Ulmer
    • 3
  • Karl-Friedrich Kreitner
    • 4
  • Hans-Ulrich Kauczor
    • 2
  1. 1.Department of Pediatric RadiologyUniversity Children’s HospitalHeidelbergGermany
  2. 2.Department of Radiology (E010)German Cancer Research Center (DKFZ)HeidelbergGermany
  3. 3.Department of CardiologyUniversity Children’s HospitalHeidelbergGermany
  4. 4.Department of RadiologyUniversity Hospital MainzMainzGermany
  5. 5.Department of Pediatric CardiologyUniversity Children’s HospitalFreiburgGermany

Personalised recommendations