Role of Magnetic Resonance Angiography in the Diagnosis of Major Aortopulmonary Collateral Arteries and Partial Anomalous Pulmonary Venous Drainage
Role of Magnetic Resonance Angiography in the Diagnosis of Major Aortopulmonary Collateral Arteries and Partial Anomalous Pulmonary Venous Drainage
复制标题
磁共振血管造影在主肺主副动脉及部分肺静脉异常引流的诊断中的作用
作者：
S. Prasad;N. Soukias;T. Hornung;M. Khan;D. Pennell;M. Gatzoulis;R. Mohiaddin
背景——对成人先天性心脏病患者的主要主动脉肺静脉循环（MAPCA）和部分异常肺静脉引流（PAPVD）的准确诊断很重要，但也存在问题。三维对比增强磁共振血管造影 (MRA) 提供了一种微创技术，可在单次屏气中进行详细研究。方法和结果——我们评估了对比增强 3D MRA 在 29 名连续成年患者中的作用，这些患者通过超声心动图、心导管插入术或手术检查诊断为 MAPCA (n=16) 或 PAPVD (n=13)。 MRA 采用 3D 破坏梯度回波技术和静脉注射钆-DTPA (0.2 mmol/kg) 进行。在这两种类型的病理学中，MRA 与心导管检查、超声心动图或手术检查之间存在极好的相关性。获得了有关 MAPCA 患者肺动脉汇合和大小（n = 13 有中央动脉）、肺动脉狭窄（n = 3）、肺动脉动脉瘤扩张（n = 1）和其他异常血管异常（n = 3）的附加信息。如果存在分流评估（16 例中的 9 例），所有病例均显示通畅（100%）。对于患有 PAPVD 的成年人，获得了有关排水源的进一步信息 (n=11)。没有出现并发症。结论 — 对比增强 3D MRA 提供了一种快速、无创、无辐射的方法，可以准确、全面地诊断成人患者的 MAPCA 和 PAPVD。
Background—Accurate diagnosis of major aortopulmonary collaterals (MAPCAs) and partial anomalous pulmonary venous drainage (PAPVD) in adult patients with congenital heart disease is important but problematic. Three-dimensional contrast-enhanced magnetic resonance angiography (MRA) provides a minimally invasive technique to allow detailed studies in a single breath-hold. Methods and Results—We assessed the role of contrast-enhanced 3D MRA in 29 consecutive adult patients with a diagnosis of MAPCAs (n=16) or PAPVD (n=13) made by echocardiogram, cardiac catheterization, or surgical inspection. MRA was performed with a 3D spoiled gradient-echo technique with intravenous gadolinium-DTPA (0.2 mmol/kg). In both types of pathology, there was excellent correlation between MRA and the cardiac catheterization, echocardiogram, or surgical inspection. Additional information was gained for patients with MAPCAs on confluence and size of pulmonary arteries (n=13 had central arteries), pulmonary artery stenosis (n=3), aneurysmal dilatation of pulmonary artery (n=1), and additional anomalous vascular abnormality (n=3). Shunt assessment, where present (9 of 16), showed patency in all cases (100%). For adults with PAPVD, further information was obtained on drainage origin (n=11). There were no complications. Conclusions—Contrast-enhanced 3D MRA provides a fast, noninvasive, radiation-free method of accurate and comprehensive diagnosis of MAPCAs and PAPVD in adult patients.