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Quantification of morphologic and hemodynamic severity of coarctation of the aorta by magnetic resonance imaging

Published online by Cambridge University Press:  15 August 2006

Matthias Gutberlet
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, Charité Campus Virchow Klinikum, Berlin, Germany
Norbert Hosten
Affiliation:
Department of Diagnostic and Neuroradiology, University Greifswald, Germany
Michael Vogel
Affiliation:
GUCH-Unit, Cardiac Services, Middlesex Hospital, London, UK
Hasim Abdul-Khaliq
Affiliation:
Department of Congenital Heart Disease, German Heart Institute Berlin, Germany
Tilman Ehrenstein
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, Charité Campus Virchow Klinikum, Berlin, Germany
Holger Amthauer
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, Charité Campus Virchow Klinikum, Berlin, Germany
Titus Hoffmann
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, Charité Campus Virchow Klinikum, Berlin, Germany
Ulf Teichgräber
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, Charité Campus Virchow Klinikum, Berlin, Germany
Felix Berger
Affiliation:
Department of Congenital Heart Disease, German Heart Institute Berlin, Germany
Peter Lange
Affiliation:
Department of Congenital Heart Disease, German Heart Institute Berlin, Germany
Roland Felix
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, Charité Campus Virchow Klinikum, Berlin, Germany

Abstract

Objective: As the morpholgic severity of coarctation of the aorta is difficult to assess, especially after previous repair, the value of the technique of multiplanar reconstruction of magnetic resonance imaging data to achieve a 3-dimensional reconstruction of the aortic arch was evaluated and compared to hemodynamic measurements. Methods and Results: We performed 30 examinations in 27 patients aged from 6 to 54 years, with a mean of 21 years, by magnetic resonance imaging using a 1.5 Tesla scanner with a standard body coil. Measurements of flow across the coarctation were performed using phase! shift velocity mapping, and peak velocity was calculated at the site of stenosis. Aortic cross-sectional area before, at, and beyond the stenosis was reconstructed 3-dimensionally to calculate a percentage degree of stenosis. Morphologic severity of stenosis was correlated to invasively assessed hemodynamic gradients and morphologic data from biplane angiography in 23 patients. Among the 30 examinations, 24 patients had been previously treated by either surgery, in 17 patients, or balloon dilation, while 6 had native coarctation. 3-dimensional reconstruction was possible in all and better delineated the anatomy concerning the hemodynamic relevance of stenoses even as compared with biplane angiography. The correlation between severity of narrowing assessed by diameter measurements in the biplane angiography and 2-dimensional magnetic resonance imaging was r = 0.94, and multiplanar reformation with 2-dimensional magnetic resonance imaging was r = 0.87 with a tendency of higher grading with the 3-dimensional technique (p = 0.0001). The correlation of 2-dimensional magnetic resonance imaging with invasively measured hemodynamic gradients was r = 0.67 versus r = 0.74 for the areas assessed by multiplanar reformation, indicating that the hemodynamic relevance of a morphological approach to evaluate the degree of a stenosis should better be assessed 3-dimensionally. Conclusions: The 3-dimensional reconstruction of the morphologic severity of coarctation offers additonal information over conventional imaging especially in patients with kinking, complex geometry, or collaterals,in whom hemodynamic measurements can become unreliable.

Type
Original Article
Copyright
2001 Cambridge University Press

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