title: Pulmonary venous evaluation using electrocardiogram-gated 64-detector row cardiac CT.
abstract: OBJECTIVE
  Radiofrequency ablation of the pulmonary veins is an accepted treatment for atrial fibrillation. An accurate knowledge of pulmonary venous anatomy and dimensions is desirable prior to such a procedure. The objective of this study was to use 64-detector row cardiac CT to investigate the changes in pulmonary venous dimensions during the cardiac cycle.
  
  
  METHODS
  Data from 44 consecutive patients with no significant cardiovascular pathology who underwent electrocardiogram (ECG)-gated 64-detector row coronary angiography were retrospectively analysed. Average diameter and cross-sectional area were measured at 5 mm intervals from each pulmonary vein ostium, in ventricular end-diastole and ventricular end-systole, using curved multiplanar reformats.
  
  
  RESULTS
  4 (9.1%) patients had pulmonary vein anomalies and were excluded. In the remaining 40 patients, pulmonary vein diameter and area at the ostium were significantly larger in end-systole in all four veins, with the largest differences in the superior pulmonary veins. Dimensional changes for diameter (millimetres) and area (square millimetres) were as follows: left superior pulmonary vein, 2.5 (p<0.001), 65.48 (p<0.001); right superior pulmonary vein, 1.63 (p<0.001), 56.27 (p<0.001); left inferior pulmonary vein, 1.1 (p<0.001), 30.41 (p<0.001); and right inferior pulmonary vein, 0.68 (p=0.005), 30.14 (p=0.005). Less marked changes were seen at measurement sites further from the atrium. Interobserver correlation was high (all but one measurement >0.9).
  
  
  CONCLUSIONS
  Pulmonary vein dimensions change significantly between end-systole and end-diastole, and the ostia of the superior pulmonary veins are potentially the most vulnerable to dimensional inaccuracies. ECG-gated cardiac CT may provide a more precise method of pulmonary venous dimensional measurement than non-gated techniques. Knowledge of change in pulmonary vein diameter offers interesting potential research into the effect of pulmonary vein function.
authors.affiliation: Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK. Nathan.manghat@UHBristol.nhs.uk
authors.forename: N E
authors.initials: NE
authors.lastname: Manghat
authors.forename: H C
authors.initials: HC
authors.lastname: Mathias
authors.forename: N
authors.initials: N
authors.lastname: Kakani
authors.forename: M C K
authors.initials: MC
authors.lastname: Hamilton
authors.forename: G
authors.initials: G
authors.lastname: Morgan-Hughes
authors.forename: C A
authors.initials: CA
authors.lastname: Roobottom
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods; D011667:Pulmonary Veins / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*