Juvenile and adult congenital heart disease: time-resolved 3D contrast-enhanced MR angiography.
OBJECTIVE
To assess the incremental diagnostic value of time-resolved three-dimensional (3D) magnetic resonance (MR) angiography over single-phase 3D MR angiography and cine MR imaging in juvenile and adult patients with congenital heart disease (CHD).


METHODS
The study was HIPAA compliant and was approved by the institutional review board. Written informed consent was obtained from each patient. Eighty-one consecutive patients (46 male and 35 female patients; mean age, 31.1 years +/- 13.5 [standard deviation]) with CHD were examined with a 1.5-T MR imaging unit. The imaging protocol comprised time-resolved MR angiography (repetition time msec/echo time msec, 2.01/0.81) after injection of 0.03 mmol gadodiamide per kilogram of body weight at 4 mL/sec and single-phase high-spatial-resolution MR angiography (2.87/0.97) after injection of 0.15 mmol/kg gadodiamide at 1.5 mL/sec. After review of the time-resolved and conventional MR angiographic data sets, each of two independent observers listed the additional clinical information gained from time-resolved MR angiographic data. A Wilcoxon signed rank test was used to test for statistical differences between the image quality ratings of the two observers.


RESULTS
Time-resolved and single-phase high-spatial-resolution MR angiography yielded diagnostic image data in all patients. Observers 1 and 2 found functional information in time-resolved MR angiographic series in 52 and 51 patients, respectively, that was not seen at high-spatial-resolution MR angiography. Intra- and extracardiac shunts, respectively, were exclusively depicted by time-resolved MR angiography for observer 1 in 18 and two patients and for observer 2 in 15 and two patients. However, both observers reported higher confidence in the assessment of such smaller vascular structures as supraaortic vessels (in 12 patients for observer 1 and 11 patients for observer 2) and major aortopulmonary collateral arteries (in eight patients for observer 1 and 10 patients for observer 2) at high-spatial-resolution MR angiography. No significant difference was evident in image quality scoring between the two observers (P = .32 for time-resolved and P = .47 for conventional MR angiography).


CONCLUSIONS
Compared with conventional MR angiography, time-resolved MR angiography yields clinically relevant information in a substantial number of patients; hence, the two techniques should be regarded as complementary.
Fenchel
Michael
M
Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str 3, 72076 Tuebingen, Germany. michael.fenchel@med.uni-tuebingen.de
Saleh
Roya
R
Dinh
Howard
H
Lee
Margaret H
MH
Nael
Kambiz
K
Krishnam
Mayil
M
Ruehm
Stefan G
SG
Miller
Stephan
S
Child
John
J
Finn
J Paul
JP
D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA