Published Online
on August 9, 2004

A more recent version of this article appeared on August 17, 2004

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Submitted on October 2, 2003
Revised on March 30, 2004
Accepted on April 2, 2004

Novel Method of Quantifying Pulmonary Vascular Resistance by Use of Simultaneous Invasive Pressure Monitoring and Phase-Contrast Magnetic Resonance Flow

Vivek Muthurangu BSc, MBChB, MRCPCH, Andrew Taylor MD, MRCP, FRCR, Rado Andriantsimiavona MSc, Sanjeet Hegde MBBS, MRCPCH, Marc E. Miquel PhD, Robert Tulloh DM, MA, MRCP, FRCPCH, Edward Baker MD, FRCP, Derek L.G. Hill PhD, and Reza S. Razavi MBBS, MRCP, MRCPCH^*

From the Cardiac MR Research Group, Division of Imaging Sciences, King’s College (V.M., A.T., R.A., S.H., M.E.M., D.L.G.H., R.S.R.); the Department of Congenital Heart Disease, Guy’s Hospital (R.T., E.B., R.S.R.); and the Cardiothoracic Unit, Institute of Child Health and Great Ormond Street Hospital (A.T.), London, United Kingdom.

^* To whom correspondence should be addressed. E-mail: reza.razavi{at}kcl.ac.uk.

Background--Pulmonary vascular resistance (PVR) quantification is important in the treatment of children with pulmonary hypertension. The Fick principle, used to quantify pulmonary artery flow, may be a flawed technique. We describe a novel method of PVR quantification by the use of magnetic resonance (MR) flow data and invasive pressure measurements.

Methods and Results--In 24 patients with either suspected pulmonary hypertension or congenital heart disease requiring preoperative assessment, PVR was calculated by the use of simultaneously acquired MR flow and invasive pressure measurements (condition 1). In 19 of the 24 patients, PVR was also calculated at 20 ppm nitric oxide +30% (condition 2) and at 20 ppm nitric oxide +100% oxygen (condition 3), with the use of the MR method. This method proved safe and feasible in all patients. In 15 of 19 patients, PVR calculated by Fick flow was compared with the MR method. At condition 1, Bland-Altman analysis revealed a bias of 2.3% (MR > Fick) and limits of agreement of 50.2% to -45.5%. At condition 2, there was poorer agreement (bias was 28%, and the limits of agreement were 151.3% to 95.2%). At condition 3, there was very poor agreement (bias was 54.2%, and the limits of agreement were 174.4% to -66.0%).

Conclusions--We have demonstrated the feasibility of using simultaneous invasive pressure measurements and MR flow data to measure PVR in humans.

Key words: vasculature • magnetic resonance imaging • catheterization

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