(Circulation. 1995;91:2955-2960.)
© 1995 American Heart Association, Inc.
Articles |
Assessment of Left-to-Right Intracardiac Shunting by Velocity-Encoded, Phase-Difference Magnetic Resonance Imaging
A Comparison With Oximetric and Indicator Dilution Techniques
From the Departments of Internal Medicine (Cardiovascular Division) (W.G.H., R.A.L., B.M.M., J.E.W., C.L., D.W., L.D.H., R.M.P.) and Radiology (H.F.L., D.P.P., R.M.P.), University of Texas Southwestern Medical Center at Dallas.
Correspondence to Ronald M. Peshock, MD, Mary Nell and Ralph B. Rogers Magnetic Resonance Center, University of Texas Southwestern Medical Center, 5801 Forest Park, Dallas, TX 75235-9085. E-mail Peshock@rad-rogers.swmed.edu.
Background Velocity-encoded, phase-difference magnetic resonance imaging (MRI) has been shown to provide an accurate assessment of shunt magnitude in patients with large atrial septal defects, but its ability to determine shunt magnitude in patients with intracardiac left-to-right shunts of various locations and sizes has not been evaluated in a prospective and blinded manner. The objective of the present study was to determine whether velocity-encoded, phase-difference MRI can assess the magnitude of intracardiac left-to-right shunting in humans.
Methods and Results Twenty-one subjects (15 women and 6 men; age
range, 15 to 72 years) underwent velocity-encoded, phase-difference MRI
measurements of flow in the proximal aorta and pulmonary artery,
followed immediately by cardiac catheterization. The presence of
left-to-right intracardiac shunting was assessed with hydrogen
inhalation, after which shunt magnitude was measured by the oximetric
and indocyanine green techniques. Of the 21 patients, 12 had
left-to-right intracardiac shunting detected by hydrogen inhalation.
There was a good correlation (r=.94) between the invasive
and MRI assessments of shunt magnitude. In comparison to oximetry and
indocyanine green, MRI correctly identified the 12 patients with a
ratio of pulmonary to systemic flow (Qp/Qs) of <1.5 (9 without
intracardiac shunting and 3 with small shunts) and the 9 patients with
a Qp/Qs of 
1.5 (6 with atrial septal defect, 1 with ventricular
septal defect, 1 with patent ductus arteriosus, and 1 with both atrial
septal defect and patent ductus arteriosus).
Conclusions Compared with measurements obtained during cardiac catheterization, velocity-encoded, phase-difference MRI measurements of flow in the proximal great vessels can reliably assess the magnitude of intracardiac left-to-right shunting.
Key Words: magnetic resonance imaging • imaging • catheterization
This article has been cited by other articles:
 |
|
 |
|
  K DEBL, B DJAVIDANI, S BUCHNER, N HEINICKE, F POSCHENRIEDER, S FEUERBACH, G RIEGGER, and A LUCHNER Quantification of left-to-right shunting in adult congenital heart disease: phase-contrast cine MRI compared with invasive oximetry Br. J. Radiol., May 1, 2009; 82(977): 386 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): e714 - e833. [Full Text] [PDF]
|
|
|
|
 |
|
 L. E.J. Thomson, A. L. Crowley, J. F. Heitner, P. J. Cawley, J. W. Weinsaft, H. W. Kim, M. Parker, R. M. Judd, J. K. Harrison, and R. J. Kim Direct En Face Imaging of Secundum Atrial Septal Defects by Velocity-Encoded Cardiovascular Magnetic Resonance in Patients Evaluated for Possible Transcatheter Closure Circ Cardiovasc Imaging, July 1, 2008; 1(1): 31 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. K. Mohrs, S. E. Petersen, D. Erkapic, A. Victor, T. Schlosser, B. Nowak, G. Kauffmann, T. Voigtlaender, and H.-U. Kauczor Dynamic Contrast-Enhanced MRI Before and After Transcatheter Occlusion of Patent Foramen Ovale Am. J. Roentgenol., March 1, 2007; 188(3): 844 - 849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Merkle and R. C. Gilkeson Remnants of Fetal Circulation: Appearance on MDCT in Adults Am. J. Roentgenol., August 1, 2005; 185(2): 541 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. K. Mohrs, S. E. Petersen, D. Erkapic, C. Rubel, R. Schrader, B. Nowak, W. A. Fach, H.-U. Kauczor, and T. Voigtlaender Diagnosis of Patent Foramen Ovale Using Contrast-Enhanced Dynamic MRI: A Pilot Study Am. J. Roentgenol., January 1, 2005; 184(1): 234 - 240. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Pennell, U. P. Sechtem, C. B. Higgins, W. J. Manning, G. M. Pohost, F. E. Rademakers, A. C. van Rossum, L. J. Shaw, and E. K. Yucel Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report Eur. Heart J., November 1, 2004; 25(21): 1940 - 1965. [Full Text] [PDF]
|
|
|
|
 |
|
 Z. J. Wang, G. P. Reddy, M. B. Gotway, B. M. Yeh, and C. B. Higgins Cardiovascular Shunts: MR Imaging Evaluation RadioGraphics, October 1, 2003; 23(90001): S181 - 194. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Morgan-Hughes, A. J. Marshall, and C. Roobottom Morphologic Assessment of Patent Ductus Arteriosus in Adults Using Retrospectively ECG-Gated Multidetector CT Am. J. Roentgenol., September 1, 2003; 181(3): 749 - 754. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Beerbaum, H. Korperich, P. Barth, H. Esdorn, J. Gieseke, and H. Meyer Noninvasive Quantification of Left-to-Right Shunt in Pediatric Patients : Phase-Contrast Cine Magnetic Resonance Imaging Compared With Invasive Oximetry Circulation, May 22, 2001; 103(20): 2476 - 2482. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. A. Ferrari, C. H. Scott, G. A. Holland, L. Axel, and M. St. John Sutton Ultrafast three-dimensional contrast-enhanced magnetic resonance angiography and imaging in the diagnosis of partial anomalous pulmonary venous drainage J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1120 - 1128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N I Stauder, S Miller, A M Scheule, G Ziemer, and C D Claussen MRI diagnosis of a previously undiagnosed large trabecular ventricular septal defect in an adult after multiple catheterizations and angiocardiograms Br. J. Radiol., March 1, 2001; 74(879): 280 - 282. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Didier, O. Ratib, R. Lerch, and B. Friedli Detection and Quantification of Valvular Heart Disease with Dynamic Cardiac MR Imaging RadioGraphics, September 1, 2000; 20(5): 1279 - 1299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.M.F. Berger Possibilities and impossibilities in the evaluation of pulmonary vascular disease in congenital heart defects Eur. Heart J., January 1, 2000; 21(1): 17 - 27. [PDF]
|
|
|
|
 |
|
 H. Arheden, C. Holmqvist, U. Thilen, K. Hanséus, G. Björkhem, O. Pahlm, S. Laurin, and F. Ståhlberg Left-to-Right Cardiac Shunts: Comparison of Measurements Obtained with MR Velocity Mapping and with Radionuclide Angiography Radiology, May 1, 1999; 211(2): 453 - 458. [Abstract] [Full Text]
|
|
|
|
|
|
G. Holmvang, I. F. Palacios, G. J. Vlahakes, R. E. Dinsmore, S. W. Miller, R. R. Liberthson, P. C. Block, B. Ballen, T. J. Brady, and H. L. Kantor Imaging and Sizing of Atrial Septal Defects by Magnetic Resonance Circulation, December 15, 1995; 92(12): 3473 - 3480. [Abstract] [Full Text]
|
|