Magnetic resonance angiography of cerebral arteries after neonatal venoarterial and venovenous extracorporeal membrane oxygenation.
OBJECTIVE
In newborns with severe respiratory failure, extracorporeal membrane oxygenation (ECMO) has been proven to improve survival. With venoarterial ECMO, the right common carotid artery is ligated, whereas with venovenous ECMO, this carotid artery remains intact. The authors present the magnetic resonance angiography (MRA) evaluation of cerebral hemodynamics in a case of venoarterial and a case of venovenous ECMO.


METHODS
With 2D phase-contrast MRA flow volume (mL/min), measurements are obtained of the brain feeding arteries and draining veins. Time-of-flight and flow-directional MRA are used to demonstrate the anatomy and flow patterns at the level of the circle of Willis.


RESULTS
A total volume flow of 63 mL/min at the skull base and collateral flow via the anterior circle of Willis were measured in the infant after venoarterial ECMO, and a total volume flow of 86 mL/min and a fetal type configuration of the circle of Willis were observed in the infant after venovenous ECMO.


CONCLUSIONS
MRA is a useful technique to quantify cerebral blood flow in neonates after venoarterial or venovenous ECMO and could be used to select neonates with insufficient collateral compensation after venoarterial ECMO, requiring revascularization surgery.
Hendrikse
Jeroen
J
Department of Radiology, University Medical Center Utrecht, The Netherlands. j.hendrikse@azu.nl
de Vries
Linda S
LS
Groenendaal
Floris
F
D002339:Carotid Arteries / Q000473:pathology*; D002536:Cerebral Arteries / Q000473:pathology; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000473:pathology; D002941:Circle of Willis / Q000473:pathology; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008858:Microscopy, Phase-Contrast; D012131:Respiratory Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D013997:Time Factors