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(Circulation. 2004;110:163-169.)
© 2004 American Heart Association, Inc.

Original Articles

Operator-Independent Isotropic Three-Dimensional Magnetic Resonance Imaging for Morphology in Congenital Heart Disease

A Validation Study

Thomas Sangild Sørensen, MSc; Hermann Körperich, PhD; Gerald F. Greil, MD; Joachim Eichhorn, MD; Peter Barth, MSc; Hans Meyer, MD; Erik Morre Pedersen, MD, PhD; Philipp Beerbaum, MD

From the Department of Cardiothoracic Surgery (T.S.S.) and MR Center (T.S.S., E.M.P.), Institute of Experimental Clinical Research, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark; Clinic for Congenital Heart Disease and Institute for Magnetic Resonance Imaging, Heart and Diabetescenter Northrhine Westfalia, Ruhr University of Bochum, Bochum, Germany (H.K., P.B., H.M., P.B.); University Hospital of Tübingen, Department of Pediatric Cardiology, Tübingen, Germany (G.F.G.); and University Hospital of Heidelberg, Department of Pediatric Cardiology, Heidelberg, Germany (J.E.).

Correspondence to Philipp Beerbaum, MD, Clinic for Congenital Heart Disease, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University of Bochum, Georgstr 11, D-32545 Bad Oeynhausen, Germany. E-mail pbeerbaum{at}hdz-nrw.de

Received January 6, 2004; revision received March 16, 2004; accepted March 23, 2004.

Background— Operator-independent isotropic 3D MRI may greatly simplify the assessment of complex morphology in congenital heart disease. We sought to evaluate the reliability of this new approach.

Methods and Results— In 31 adolescent and adult patients (age, 6 to 42 years; median, 16 years) with congenital heart disease, cardiac morphology was determined with free-breathing (navigator-gated), isotropic, 3D steady-state free-precession (3D SSFP) MRI and independently evaluated by 2 observers. Cardiac diagnoses and multiple distance measurements were compared with conventional MR reference sequences (ie, spin-echo, cine gradient-echo, contrast-enhanced MR angiography) and with echocardiography/cine cardioangiography or surgery. Of the 31 patients, 24 had native congenital heart defects or residual defects after repair that warranted immediate treatment. None of these defects was missed by 3D SSFP. Novel diagnostic issues were discovered in 4 of 31 patients (coronary anomalies, n=3; left juxtaposition of the right atrial appendage in double-outlet right ventricle and transposition of the great arteries, 1). For sizes of valves and vessels, we found minor mean differences of –1.1 to 1.6 mm, with SD ranging from 1.2 to 2.9 mm, demonstrating overall good agreement with standard MRI (Bland-Altman analysis). Interobserver variability of 3D SSFP distance measures was low; mean differences ranged from –1.5 to 1.0 mm, and SD ranged from 0.8 to 2.5 mm. Scatter was lower for extracardiac than intracardiac measures.

Conclusions— In adolescents and adults, isotropic 3D SSFP MRI allows reliable assessment of complex cardiac morphology. Distance measurements are accurate and reproducible. Thus, a single operator-independent acquisition may substitute for conventional 2D MRI sequences to accelerate and simplify MR scanning in congenital heart disease.

Key Words: computers • heart defects, congenital • magnetic resonance imaging • pediatrics

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