Gadolinium-enhanced 3-dimensional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia - Comparison with X-ray angiography
Gadolinium-enhanced 3-dimensional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia - Comparison with X-ray angiography
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DOI：
10.1161/01.cir.0000023624.33478.18
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发表时间：
2002-07-23
期刊：
影响因子：
37.8
通讯作者：
Powell, AJ
中科院分区：
文献类型：
--
作者：
Geva, T;Greil, GF;Powell, AJ
背景-在复杂肺动脉狭窄或闭锁患者中，详细描述所有肺血供来源对于计划外科手术和经导管手术是必要的，通常需要诊断性心导管插入术。本研究的目的是确定钆增强三维磁共振血管造影（MRA）是否可以提供一种非侵入性的替代诊断导管插入术，并比较MRA和X线血管造影测量肺动脉和肺动脉闭锁侧支循环（APC）。（中位年龄：4.7岁，范围：1天至46.9岁）进行了MRA和心导管检查（中位时间：1个月）。法洛四联症合并肺动脉闭锁13例，法洛四联症合并肺动脉狭窄4例，Fontan术后姑息治疗5例。其他复杂先天性心脏病10例。与导管和手术观察相比，MRA对主肺动脉（n=10）和分支肺动脉（PA）狭窄或发育不良（n=38）以及分支PA缺失（n=5）或不连续（n=4）的诊断敏感性和特异性均为100%。所有48例经导管诊断的主要APC均经MRA正确诊断。另外三个APC被MRA诊断，但不是通过导管。33支肺血管直径的MRA和导管测量值之间的平均差异为0.5 ± 1.5 mm，平均观察者间差异为0.4+/-1.5 mm。增强3D MRA是一种快速准确的技术，可用于描绘复杂肺动脉狭窄和闭锁患者的所有肺血供来源，导管插入术和X射线血管造影术。
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: I day to 46.9 years) underwent both MRA and cardiac catheterization (median time: I 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.