(Circulation. 2001;103:2476.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Noninvasive Quantification of Left-to-Right Shunt in Pediatric Patients
Phase-Contrast Cine Magnetic Resonance Imaging Compared With Invasive Oximetry
From the Clinic for Congenital Heart Disease, Heart and Diabetes Center, North Rhine-Westfalia, Ruhr-University Bochum, Germany; and Philips Medical Systems, Best, Netherlands (J.G.).
Correspondence to Philipp Beerbaum, MD, Clinic for Congenital Heart Disease, Heart and Diabetes Center, North Rhine-Westfalia, Ruhr-University Bochum, Georgstraße 11, D-32545 Bad Oeynhausen, Germany. E-mail pbeerbaum{at}hdz-nrw.de
Background—Blood flow can be quantified noninvasively by phase-contrast cine MRI (PC-MRI) in adults. Little is known about the feasibility of the method in children with congenital heart disease.
Methods and Results—In
50 children (mean age 6.2 years, range 1.1 to 17.7 years) with an
atrial- or ventricular-level shunt, blood flow rate in the
great vessels was determined by PC-MRI, and the ratio of
pulmonary to aortic flow (
p/s) was
compared with p/s by oximetry. We found a
difference of 2% and a range of -20% to +26% (limits of agreement,
mean±2 SD). In another 7 children with congenital heart disease but no
cardiac shunting (mean age 7.9 years, range 1.3 to 13.5 years),
p/s by PC-MRI was 1.02 (SD ±0.06). No difference
between systemic venous and aortic flow volumes was found (range
-17% to +20%, n=37). Blood flow through a secundum atrial septal
defect as assessed by PC-MRI (n=24) overestimated the shunt compared
with the difference between pulmonary and aortic flows. The
mean difference between 3 repeated PC-MRI measurements in each location
was 5.3% (SD ±4.0%, n=522), demonstrating good precision. The
interobserver variability was low. The accuracy of PC-MRI was confirmed
by in vitro experiments.
Conclusions—Determination
of p/s by PC-MRI in children is quick, safe, and
reliable compared with oximetry. Systemic venous flow can be quantified
by PC-MRI, whereas through-plane shunt measurement within an atrial
septal defect is inaccurate.
Key Words: heart defects, congenital • pediatrics • magnetic resonance imaging • shunts • veins
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