Time-Resolved Contrast-Enhanced MR Angiography of the Thorax in Adults with Congenital Heart Disease
Oliver K. Mohrs1,2,
Steffen E. Petersen3,
Thomas Voigtlaender4,
Jutta Peters5,
Bernd Nowak4,
Markus K. Heinemann6 and
Hans-Ulrich Kauczor2
1 Darmstadt Radiology, Department of Cardiovascular Imaging at Alice Hospital,
Dieburger Strasse 29-13, 64287 Darmstadt, Germany.
2 Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg,
Germany.
3 University of Oxford, Centre for Clinical MR Research (OCMR), Oxford, United
Kingdom.
4 Department of Cardiology, Cardiovascular Center Bethanien (CCB),
Frankfurt/Main, Germany.
5 Department of Radiology, University of Frankfurt, Frankfurt/Main,
Germany.
6 Department of Pediatric Surgery, University of Mainz, Mainz, Germany.
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Fig. 1A —23-year-old woman referred to MRI with suspicion of
transposition of great arteries because of prominent trabeculation of
subaortic ventricle in echocardiography. Time-resolved coronal
maximum-intensity-projection angiograms (A-C) and cine short-axis view
(D). The angiograms show normal time course of enhancement of
subpulmonary atrium and ventricle and pulmonary arteries (A); and
enhancement of pulmonary veins, subaortic atrium, ventricle, and aorta
(B). Note decreasing enhancement of subpulmonary ventricle from
A to C, indicating absence of relevant left-to-right shunt flow.
This patient suffered from noncompaction myocardium, which is visualized on
time-resolved MR angiography (C) (arrow) and is shown on cine
short-axis view (D) (arrows). See also Figure S1, cine loop,
in supplemental data online
(www.ajronline.org).
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Fig. 1B —23-year-old woman referred to MRI with suspicion of
transposition of great arteries because of prominent trabeculation of
subaortic ventricle in echocardiography. Time-resolved coronal
maximum-intensity-projection angiograms (A-C) and cine short-axis view
(D). The angiograms show normal time course of enhancement of
subpulmonary atrium and ventricle and pulmonary arteries (A); and
enhancement of pulmonary veins, subaortic atrium, ventricle, and aorta
(B). Note decreasing enhancement of subpulmonary ventricle from
A to C, indicating absence of relevant left-to-right shunt flow.
This patient suffered from noncompaction myocardium, which is visualized on
time-resolved MR angiography (C) (arrow) and is shown on cine
short-axis view (D) (arrows). See also Figure S1, cine loop,
in supplemental data online
(www.ajronline.org).
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Fig. 1C —23-year-old woman referred to MRI with suspicion of
transposition of great arteries because of prominent trabeculation of
subaortic ventricle in echocardiography. Time-resolved coronal
maximum-intensity-projection angiograms (A-C) and cine short-axis view
(D). The angiograms show normal time course of enhancement of
subpulmonary atrium and ventricle and pulmonary arteries (A); and
enhancement of pulmonary veins, subaortic atrium, ventricle, and aorta
(B). Note decreasing enhancement of subpulmonary ventricle from
A to C, indicating absence of relevant left-to-right shunt flow.
This patient suffered from noncompaction myocardium, which is visualized on
time-resolved MR angiography (C) (arrow) and is shown on cine
short-axis view (D) (arrows). See also Figure S1, cine loop,
in supplemental data online
(www.ajronline.org).
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Fig. 1D —23-year-old woman referred to MRI with suspicion of
transposition of great arteries because of prominent trabeculation of
subaortic ventricle in echocardiography. Time-resolved coronal
maximum-intensity-projection angiograms (A-C) and cine short-axis view
(D). The angiograms show normal time course of enhancement of
subpulmonary atrium and ventricle and pulmonary arteries (A); and
enhancement of pulmonary veins, subaortic atrium, ventricle, and aorta
(B). Note decreasing enhancement of subpulmonary ventricle from
A to C, indicating absence of relevant left-to-right shunt flow.
This patient suffered from noncompaction myocardium, which is visualized on
time-resolved MR angiography (C) (arrow) and is shown on cine
short-axis view (D) (arrows). See also Figure S1, cine loop,
in supplemental data online
(www.ajronline.org).
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Fig. 2A —29-year-old woman with D-transposition of great arteries as
result of undergoing Mustard atrial switch procedure during childhood. Coronal
cine view (A) shows small systemic venous pathways (asterisks)
from inferior and superior vena cava to subpulmonary ventricle (morphology of
left ventricle) and pulmonary venous pathway (arrow), which is
connected to subaortic ventricle (morphology of right ventricle). Single slice
of coronal time-resolved MR angiography shows small systemic venous pathways
(B), and sagittal angiogram shows pulmonary venous pathway (C)
(arrow). On chest radiograph (D), which is gray-scale
manipulated, pacemaker probe (implanted after MRI) shows course of blood flow
(arrows) from superior vena cava after undergoing Mustard atrial
switch. Ao = aorta, SVC = superior vena cava, PT = pulmonary trunk, IVC =
inferior vena cava, spV = subpulmonary ventricle, saV = subaortic
ventricle.
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Fig. 2B —29-year-old woman with D-transposition of great arteries as
result of undergoing Mustard atrial switch procedure during childhood. Coronal
cine view (A) shows small systemic venous pathways (asterisks)
from inferior and superior vena cava to subpulmonary ventricle (morphology of
left ventricle) and pulmonary venous pathway (arrow), which is
connected to subaortic ventricle (morphology of right ventricle). Single slice
of coronal time-resolved MR angiography shows small systemic venous pathways
(B), and sagittal angiogram shows pulmonary venous pathway (C)
(arrow). On chest radiograph (D), which is gray-scale
manipulated, pacemaker probe (implanted after MRI) shows course of blood flow
(arrows) from superior vena cava after undergoing Mustard atrial
switch. Ao = aorta, SVC = superior vena cava, PT = pulmonary trunk, IVC =
inferior vena cava, spV = subpulmonary ventricle, saV = subaortic
ventricle.
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Fig. 2C —29-year-old woman with D-transposition of great arteries as
result of undergoing Mustard atrial switch procedure during childhood. Coronal
cine view (A) shows small systemic venous pathways (asterisks)
from inferior and superior vena cava to subpulmonary ventricle (morphology of
left ventricle) and pulmonary venous pathway (arrow), which is
connected to subaortic ventricle (morphology of right ventricle). Single slice
of coronal time-resolved MR angiography shows small systemic venous pathways
(B), and sagittal angiogram shows pulmonary venous pathway (C)
(arrow). On chest radiograph (D), which is gray-scale
manipulated, pacemaker probe (implanted after MRI) shows course of blood flow
(arrows) from superior vena cava after undergoing Mustard atrial
switch. Ao = aorta, SVC = superior vena cava, PT = pulmonary trunk, IVC =
inferior vena cava, spV = subpulmonary ventricle, saV = subaortic
ventricle.
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Fig. 2D —29-year-old woman with D-transposition of great arteries as
result of undergoing Mustard atrial switch procedure during childhood. Coronal
cine view (A) shows small systemic venous pathways (asterisks)
from inferior and superior vena cava to subpulmonary ventricle (morphology of
left ventricle) and pulmonary venous pathway (arrow), which is
connected to subaortic ventricle (morphology of right ventricle). Single slice
of coronal time-resolved MR angiography shows small systemic venous pathways
(B), and sagittal angiogram shows pulmonary venous pathway (C)
(arrow). On chest radiograph (D), which is gray-scale
manipulated, pacemaker probe (implanted after MRI) shows course of blood flow
(arrows) from superior vena cava after undergoing Mustard atrial
switch. Ao = aorta, SVC = superior vena cava, PT = pulmonary trunk, IVC =
inferior vena cava, spV = subpulmonary ventricle, saV = subaortic
ventricle.
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Fig. 3A —46-year-old woman with persistent left superior vena cava. MR
angiography image shows drainage of left superior vena cava (arrows)
into right atrium via coronary sinus. To diagnose a persistent left superior
vena cava, it is mandatory to inject contrast agent from left arm.
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Fig. 3B —46-year-old woman with persistent left superior vena cava.
This finding was verified in oblique sagittal cine imaging (arrows).
RA = right atrium, LA = left atrium, IVC = inferior vena cava.
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Fig. 4A —42-year-old woman with heterotaxia syndrome (levoloop
ventricle and dextroloop vessels). Time-resolved angiogram (A) shows
subaortic ventricle (saV) and course of aorta (Ao) with excellent image
quality. One of last angiograms at time of parenchymal enhancement; reflow of
contrast agent from lower body clearly shows continuity of azygos vein
(B) (arrows) draining into superior vena cava. PT = pulmonary
trunk, spA = subpulmonary atrium, spV = subpulmonary ventricle. See also
Figure S4, cine loop, in supplemental data online
(www.ajronline.org).
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Fig. 4B —42-year-old woman with heterotaxia syndrome (levoloop
ventricle and dextroloop vessels). Time-resolved angiogram (A) shows
subaortic ventricle (saV) and course of aorta (Ao) with excellent image
quality. One of last angiograms at time of parenchymal enhancement; reflow of
contrast agent from lower body clearly shows continuity of azygos vein
(B) (arrows) draining into superior vena cava. PT = pulmonary
trunk, spA = subpulmonary atrium, spV = subpulmonary ventricle. See also
Figure S4, cine loop, in supplemental data online
(www.ajronline.org).
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Fig. 5A —21-year-old man with criss-cross heart. One of first coronal
time-resolved angiograms (A) shows enhancement of subaortic atrium,
subaortic ventricle (saV), and aorta (Ao), indicating that systemic venous
drainage (contrast agent injection from left antecubital vein) goes directly
to systemic arterial circulation. Some seconds later, angiogram shows
enhancement of subpulmonary ventricle (spV) and pulmonary trunk (PT) caused by
large ventricular septal defect (B) (asterisk). Oblique
coronal cine view (C) verifies complex anatomy. Asterisks in A-C
show connection between subpulmonary atrium and subaortic ventricle. During
childhood patient received surgical shunt between left subclavian artery and
pulmonary artery (D) that was not detected on time-resolved MR
angiography, most likely because of small prosthesis diameter. Nevertheless,
aortic course was diagnosed as abnormal using our binary approach and
therefore high-resolution contrast-enhanced MR angiography was performed,
which allowed correct diagnosis. spA = subpulmonary atrium. See also Figure
S5, cine loop, in supplemental data online
(www.ajronline.org).
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Fig. 5B —21-year-old man with criss-cross heart. One of first coronal
time-resolved angiograms (A) shows enhancement of subaortic atrium,
subaortic ventricle (saV), and aorta (Ao), indicating that systemic venous
drainage (contrast agent injection from left antecubital vein) goes directly
to systemic arterial circulation. Some seconds later, angiogram shows
enhancement of subpulmonary ventricle (spV) and pulmonary trunk (PT) caused by
large ventricular septal defect (B) (asterisk). Oblique
coronal cine view (C) verifies complex anatomy. Asterisks in A-C
show connection between subpulmonary atrium and subaortic ventricle. During
childhood patient received surgical shunt between left subclavian artery and
pulmonary artery (D) that was not detected on time-resolved MR
angiography, most likely because of small prosthesis diameter. Nevertheless,
aortic course was diagnosed as abnormal using our binary approach and
therefore high-resolution contrast-enhanced MR angiography was performed,
which allowed correct diagnosis. spA = subpulmonary atrium. See also Figure
S5, cine loop, in supplemental data online
(www.ajronline.org).
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View larger version (180K):
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Fig. 5C —21-year-old man with criss-cross heart. One of first coronal
time-resolved angiograms (A) shows enhancement of subaortic atrium,
subaortic ventricle (saV), and aorta (Ao), indicating that systemic venous
drainage (contrast agent injection from left antecubital vein) goes directly
to systemic arterial circulation. Some seconds later, angiogram shows
enhancement of subpulmonary ventricle (spV) and pulmonary trunk (PT) caused by
large ventricular septal defect (B) (asterisk). Oblique
coronal cine view (C) verifies complex anatomy. Asterisks in A-C
show connection between subpulmonary atrium and subaortic ventricle. During
childhood patient received surgical shunt between left subclavian artery and
pulmonary artery (D) that was not detected on time-resolved MR
angiography, most likely because of small prosthesis diameter. Nevertheless,
aortic course was diagnosed as abnormal using our binary approach and
therefore high-resolution contrast-enhanced MR angiography was performed,
which allowed correct diagnosis. spA = subpulmonary atrium. See also Figure
S5, cine loop, in supplemental data online
(www.ajronline.org).
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View larger version (137K):
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Fig. 5D —21-year-old man with criss-cross heart. One of first coronal
time-resolved angiograms (A) shows enhancement of subaortic atrium,
subaortic ventricle (saV), and aorta (Ao), indicating that systemic venous
drainage (contrast agent injection from left antecubital vein) goes directly
to systemic arterial circulation. Some seconds later, angiogram shows
enhancement of subpulmonary ventricle (spV) and pulmonary trunk (PT) caused by
large ventricular septal defect (B) (asterisk). Oblique
coronal cine view (C) verifies complex anatomy. Asterisks in A-C
show connection between subpulmonary atrium and subaortic ventricle. During
childhood patient received surgical shunt between left subclavian artery and
pulmonary artery (D) that was not detected on time-resolved MR
angiography, most likely because of small prosthesis diameter. Nevertheless,
aortic course was diagnosed as abnormal using our binary approach and
therefore high-resolution contrast-enhanced MR angiography was performed,
which allowed correct diagnosis. spA = subpulmonary atrium. See also Figure
S5, cine loop, in supplemental data online
(www.ajronline.org).
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