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Diagnosis of Patent Foramen Ovale Using Contrast-Enhanced Dynamic MRI: A Pilot Study

¹ Department of Cardiovascular MRI, Cardiovascular Center Bethanien, Im Pruefling 17, D-60389 Frankfurt/Main, Germany.
² German Cancer Research Center (DKFZ), Heidelberg, Germany.
³ University of Oxford Centre for Cardiovascular Magnetic Resonance, John Radcliffe Hospital, Oxford, England.

View larger version (120K): [in a new window]   Fig. 1A. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (66K): [in a new window]   Fig. 1B. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (74K): [in a new window]   Fig. 1C. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (83K): [in a new window]   Fig. 1D. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (83K): [in a new window]   Fig. 1E. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (93K): [in a new window]   Fig. 1F. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (92K): [in a new window]   Fig. 1G. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (127K): [in a new window]   Fig. 1H. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (74K): [in a new window]   Fig. 1I. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (80K): [in a new window]   Fig. 1J. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (87K): [in a new window]   Fig. 1K. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (86K): [in a new window]   Fig. 1L. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (98K): [in a new window]   Fig. 1M. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (101K): [in a new window]   Fig. 1N. —32-year-old man with patent foramen ovale grade 3 on transesophageal echocardiography and grade 3 on MRI. Figures 1A and 1H show anatomy using true fast imaging with steady-state free precession–cine sequence in horizontal long axis (A) and short axis (H) at atrial level. Figures 1B–1G and 1I–1N show temporal sequence of contrast-enhanced dynamic perfusion imaging during Valsalva maneuver. Figures 1B and 1I show baseline signal without enhancement. Figures 1C and 1J show enhancement of right atrium (RA). Figures 1D and 1K show enhancement of entire left atrium (LA) due to right-to-left shunting (arrows) before enhancement of pulmonary vein (PV). Figures 1E and 1L show signal decrease in LA representing dip after first initial peak back to baseline. Figures 1F and 1M show enhancement of PV and second signal peak in LA. Figures 1G and 1N show enhancement of aorta. RV = right ventricle, LV = left ventricle, RV = right ventricle, Ao = aorta, PA = pulmonary artery.

View larger version (160K): [in a new window]   Fig. 2A. —32-year-old man with atrial septal aneurysm (arrow) on MRI. Typical bulging of atrial septum is shown toward left atrium (LA) in horizontal long axis (A) and toward right atrium (RA) in short axis (B).

View larger version (142K): [in a new window]   Fig. 2B. —32-year-old man with atrial septal aneurysm (arrow) on MRI. Typical bulging of atrial septum is shown toward left atrium (LA) in horizontal long axis (A) and toward right atrium (RA) in short axis (B).

View larger version (12K): [in a new window]   Fig. 3. —Graph of signal–time curve in 32-year-old man with patent foramen ovale shows early initial signal peak (arrow) in left atrium () followed by second higher peak before peak in pulmonary vein ().

View larger version (10K): [in a new window]   Fig. 4. —Graph of typical signal–time curve in 26-year-old man without patent foramen ovale shows single peak in left atrium () at almost same time as peak in pulmonary vein ().

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