title: Assessment of left-to-right intracardiac shunting by velocity-encoded, phase-difference magnetic resonance imaging. A comparison with oximetric and indicator dilution techniques.
abstract: 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.
  
  
  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 > or = 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.
authors.affiliation: Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center at Dallas, USA.
authors.forename: W G
authors.initials: WG
authors.lastname: Hundley
authors.forename: H F
authors.initials: HF
authors.lastname: Li
authors.forename: R A
authors.initials: RA
authors.lastname: Lange
authors.forename: D P
authors.initials: DP
authors.lastname: Pfeifer
authors.forename: B M
authors.initials: BM
authors.lastname: Meshack
authors.forename: J E
authors.initials: JE
authors.lastname: Willard
authors.forename: C
authors.initials: C
authors.lastname: Landau
authors.forename: D
authors.initials: D
authors.lastname: Willett
authors.forename: L D
authors.initials: LD
authors.lastname: Hillis
authors.forename: R M
authors.initials: RM
authors.lastname: Peshock
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D005260:Female; D006321:Heart / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007201:Indicator Dilution Techniques; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D011651:Pulmonary Artery / Q000503:physiopathology*