title: Contrast-enhanced MR angiography of cavopulmonary connections in adult patients with congenital heart disease.
abstract: OBJECTIVE
  The purpose of this study is to evaluate combined time-resolved and high-spatial resolution contrast-enhanced MR angiography (MRA) for assessment of cavopulmonary connections in adult patients with congenital heart disease.
  
  
  METHODS
  Twenty-eight adults with various surgical cavopulmonary connections (Glenn shunt and Fontan connection) underwent high-spatial-resolution contrast-enhanced MRA (voxel size, 1.95 mm(3); temporal resolution, 22 seconds) and time-resolved contrast-enhanced MRA (voxel size, 6.5-9.3 mm(3); temporal resolution, < 1.2 seconds). Ten patients had 2D phase contrast flow quantification measurements performed at the same setting. Two readers independently assessed anatomic dimensions of cavopulmonary connections (using high-spatial-resolution contrast-enhanced MRA) and pulmonary artery (PA) perfusion patterns (using time-resolved contrast-enhanced MRA).
  
  
  RESULTS
  High-spatial-resolution contrast-enhanced MRA yielded diagnostic-quality images for morphologic assessment of cavopulmonary connections in 27 of 28 (96%) patients. The anatomic dimensions (cross-sectional area) of the PA and cavopulmonary connections showed a wide variation (right PA, 0.99-5.67 cm(2); left PA, 0.80-5.69 cm(2); Glenn shunt, 0.93-6.94 cm(2); and Fontan connection, 1.25-6.67 cm(2)). The anatomic dimensions could be assessed with excellent interobserver agreement on high-spatial-resolution contrast-enhanced MRA (r = 0.895). Time-resolved contrast-enhanced MRA yielded diagnostic-quality images in all patients and enabled characterization of PA perfusion via the superior vena cava as follows: preferential inflow to the right PA (n = 12), preferential inflow to the left PA (n = 5), and balanced inflow to the right and left PA (n = 11). In those patients who had technically successful flow quantification measurements, phase contrast data confirmed patency of the cavopulmonary connections.
  
  
  CONCLUSIONS
  Combined time-resolved contrast-enhanced MRA and high-spatial-resolution contrast-enhanced MRA allowed detailed morphologic and dynamic evaluation of cavopulmonary connections in adult patients with congenital heart disease. A wide variation in anatomic dimensions and perfusion patterns was confidently identified in this patient population.
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Wagner
authors.forename: Kim-Lien
authors.initials: KL
authors.lastname: Nguyen
authors.forename: Sarah
authors.initials: S
authors.lastname: Khan
authors.forename: Saeed
authors.initials: S
authors.lastname: Mirsadraee
authors.forename: Gary M
authors.initials: GM
authors.lastname: Satou
authors.forename: Jamil
authors.initials: J
authors.lastname: Aboulhosn
authors.forename: J Paul
authors.initials: JP
authors.lastname: Finn
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003287:Contrast Media; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media