[Comparison between biventricular cine MRI and MR flow quantification in ascending aorta and pulmonary outflow tract for the assessment of intracardial shunt volumes].
OBJECTIVE
Comparison between biventricular volumetric measurements and flow measurements in ascending aorta (Ao) and pulmonary outflow tract (Pu) for quantification of intracardial shunts, and evaluation of the combination of biventricular cine MRI with flow measurements for the assessment of RV and LV heart failure and valvular regurgitation (VR).


METHODS
In 24 patients, right (RV) and left (LV) ventricular volumetric and flow measurements were performed in the Ao and Pu to assess the ratio of RV stroke volume (SV) or, respectively, pulmonary SV to LV SV or, respectively, systemic aortic SV (Qp/Qs). 34 patients without echocardiographically proven shunt or VR served as control group for measurement accuracy. Left-to-right shunt ratios were calculated from RV and LV SV, Pu and Ao SV, Pu and LV SV, and RV and Ao SV. Left ventricular VR was calculated by the difference of LV SV and Ao SV, and right ventricular VR by the difference of RV SV and Pu SV. Global systolic function was evaluated by biventricular cine MRI.


RESULTS
Intracardial shunts with Qp/Qs > 1.16 can be quantified by flow measurements in Ao and Pu. Using biventricular volumetric measurements in cases without VR, requires a Qp/Qs > 1.21. 17 of 18 intracardiac shunts were identified on MRI, and all 8 hemodynamically significant shunts were quantitatively confirmed. The diagnosis of complete shunt closure or absent shunt was correctly made in all 6 cases. RV EF reduction was found in 6 of 24 patients. LV EF reduction was also found in 6 of 24 patients.


CONCLUSIONS
Flow measurements in Ao and Pu are more accurate than biventricular cine MRI for the assessment of Qp/Qs ratios. Flow measurements in Ao and Pu combined with biventricular cine MRI enables the quantification of hemodynamic significant shunts, higher grade VR and biventricular global systolic function with a single examination.
Rominger
M B
MB
Abteilung Strahlendiagnostik, Philipps-Universität Marburg, Germany. Rominger@med.uni-marburg.de
Kluge
A
A
Dinkel
H-P
HP
Bachmann
G F
GF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000502:physiology*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology; D002306:Cardiac Volume; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000503:physiopathology; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology; D003326:Coronary Circulation; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006343:Heart Septal Defects / Q000175:diagnosis / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D011651:Pulmonary Artery / Q000502:physiology*; D011652:Pulmonary Circulation; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D013318:Stroke Volume; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology