Published Online
on July 1, 2002

A more recent version of this article appeared on July 23, 2002

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Submitted on April 2, 2002
Revised on April 11, 2002
Accepted on May 9, 2002

Gadolinium-Enhanced 3-Dimensional Magnetic Resonance Angiography of Pulmonary Blood Supply in Patients With Complex Pulmonary Stenosis or Atresia. Comparison With X-Ray Angiography

Tal Geva MD^*, Gerald F. Greil MD, Audrey C. Marshall MD, Michael Landzberg MD, and Andrew J. Powell MD

From the Departments of Cardiology (T.G., G.F.G., A.C.M., M.L., A.J.P.) and Radiology (T.G.), Children's Hospital, and the Departments of Pediatrics (T.G., G.F.G., A.C.M., M.L., A.J.P.) and Radiology (T.G.), Harvard Medical School, Boston, Mass.

^* To whom correspondence should be addressed. E-mail: tal.geva{at}tch.harvard.edu.

Background—In patients with complex pulmonary stenosis or atresia, a detailed delineation of all sources of pulmonary blood supply is necessary for planning surgical and transcatheter procedures and usually requires diagnostic cardiac catheterization. The goals of this study were to determine whether gadolinium-enhanced 3D magnetic resonance angiography (MRA) can provide a noninvasive alternative to diagnostic catheterization and to compare MRA and x-ray angiography measurements of pulmonary arteries and aortopulmonary collaterals (APCs).

Methods and Results—Thirty-two patients with pulmonary stenosis or atresia (median age: 4.7 years, range: 1 day to 46.9 years) underwent both MRA and cardiac catheterization (median time: 1 month). Diagnoses included tetralogy of Fallot (TOF) with pulmonary atresia (n=13), TOF with pulmonary stenosis (n=4), post-Fontan palliation (n=5), and other complex congenital heart disease (n=10). Compared with catheterization and surgical observations, MRA had a 100% sensitivity and specificity for the diagnosis of main (n=10) and branch pulmonary artery (PA) stenosis or hypoplasia (n=38), as well as absent (n=5) or discontinuous (n=4) branch PAs. All 48 major APCs diagnosed by catheterization were correctly diagnosed by MRA. Three additional APCs were diagnosed by MRA but not by catheterization. The mean difference between MRA and catheterization measurements of 33 pulmonary vessel diameters was 0.5±1.5 mm, with a mean interobserver difference of 0.4±1.5 mm.

Conclusions—Gadolinium-enhanced 3D MRA is a fast and accurate technique for delineation of all sources of pulmonary blood supply in patients with complex pulmonary stenosis and atresia and can be considered a noninvasive alternative to diagnostic catheterization with x-ray angiography.

Key words: heart defects, congenital • magnetic resonance imaging • catheterization • pulmonary heart disease

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