title: A method for the determination of proximal pulmonary vein size using contrast-enhanced magnetic resonance angiography.
abstract: OBJECTIVE
  We sought to develop a reproducible method for characterizing the anatomy of the proximal pulmonary veins.
  
  
  BACKGROUND
  Contrast-enhanced three-dimensional magnetic resonance angiography (CE-MRA) is a commonly requested test before and after radiofrequency ablation for the treatment of atrial fibrillation. While CE-MRA readily visualizes the pulmonary veins, there is no standardized method for determining their size and cross-sectional anatomy.
  
  
  METHODS
  Data for 24 consecutive patients referred for pulmonary vein CE-MRA before an elective ablation procedure for the treatment of atrial fibrillation were analyzed. Detailed measurements of the pulmonary vein diameter, circumference, and cross-sectional area were obtained at three locations: the juncture of the pulmonary vein with the left atrium (LA) (position 1J), the narrowest segment within 5 mm of the juncture (position 2(5mm)), and at the location in the sagittal plane at which the pulmonary veins separate from the LA and from each other (position 3Sag). Intraobserver and interobserver variabilities were also determined for each method.
  
  
  RESULTS
  The left lower pulmonary vein was significantly smaller than the other pulmonary veins at positions 1J and 2(5mm) (p<0.05). The right upper pulmonary vein was significantly larger than the other pulmonary vein at position 3Sag (p<0.05). At positions 1J and 2(5mm), the diameter had a low correlation with the circumference and cross-sectional area. At position 3Sag, the major and minor axis dimensions had a very high correlation with the circumference and cross-sectional area. The intraobserver and interobserver variabilities were substantially lower (better) for position 3Sag.
  
  
  CONCLUSIONS
  Pulmonary vein diameter measurements are highly variable and do not reflect true anatomic variation in cross-sectional anatomy. A sagittal method of determining pulmonary vein size was highly reproducible and may therefore be advantageous for use in patients likely to need serial examinations.
authors.affiliation: Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. thauser@bidmc.harvard.edu
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Hauser
authors.forename: Susan B
authors.initials: SB
authors.lastname: Yeon
authors.forename: Seth
authors.initials: S
authors.lastname: McClennen
authors.forename: George
authors.initials: G
authors.lastname: Katsimaglis
authors.forename: Kraig V
authors.initials: KV
authors.lastname: Kissinger
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
authors.forename: Neil M
authors.initials: NM
authors.lastname: Rofsky
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery; D017115:Catheter Ablation; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000473:pathology* / Q000601:surgery; D011856:Radiographic Image Enhancement; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media