Measurement of Pulmonary Circulation Parameters Using Time-Resolved MR Angiography in Patients After Ross Procedure

Lakoma, Anna; Tuite, David; Sheehan, John J.; Weale, Peter; Carr, James C.

doi:10.2214/ajr.09.2897

Cited by 22 publications

(18 citation statements)

References 19 publications

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“…It has been suggested that an increase in pulmonary blood volume is the main reason for vascular remodeling and resultant pulmonary hypertension during chronic hypoxia (19). Such increases have also been found to be correlated with measures of RV dysfunction such as lower ejection fraction and ventricular dilation (17). The result of our study shows the arterial blood volume in patients with PAH is significantly higher than controls.…”

Section: Discussionmentioning

confidence: 99%

Time‐resolved magnetic resonance angiography: Evaluation of intrapulmonary circulation parameters in pulmonary arterial hypertension

Jeong

Vakil

Sheehan

et al. 2010

Magnetic Resonance Imaging

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Purpose: To determine whether pulmonary arterial and venous transit times measured by time-resolved magnetic resonance angiography (MRA) can be used as a diagnostic tool for pulmonary arterial hypertension (PAH). Materials and Methods:Twelve patients with confirmed PAH and 10 healthy volunteers were scanned with Institutional Review Board (IRB) approval. Time-resolved MRA and 2D phase contrast flow images of the pulmonary vasculature were acquired. Pulmonary arterial and venous transit times (PaTT and PvTT) and pulmonary valve flow (PVF) were obtained. Pulmonary arterial and pulmonary venous blood volumes (PaBV and PvBV) were calculated as the product of flow and transit time.Results: Patients with PAH showed statistically significant increases in PaTT and PvTT (P < 0.0004, P < 0.05, respectively) compared to controls. PaBV (165.2 6 92.0 mL) was significantly higher in PAH subjects than controls (97.0 6 47.1 mL) (P < 0.04), whereas PvBV (127.9 6 148.9 mL) of PAH subjects had no significant increase from those of healthy controls (142.5 6 104.1 mL) (P < 0.38).Conclusion: Pulmonary arterial transit times measured using time-resolved MRA can be used as a simple, noninvasive metric for detection of altered hemodynamics in PAH.

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Section: Discussionmentioning

confidence: 99%

Time‐resolved magnetic resonance angiography: Evaluation of intrapulmonary circulation parameters in pulmonary arterial hypertension

Jeong

Vakil

Sheehan

et al. 2010

Magnetic Resonance Imaging

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“…3,4 Dynamic contrast-enhanced (DCE) time-resolved magnetic resonance (MR) imaging is a technique whereby an intravenous contrast bolus can be tracked through the cardiopulmonary vascular system in three dimensions with time. [5][6][7][8][9][10][11][12] Several previous studies have assessed DCE-MR in patients with pulmonary hypertension, 8,9,[13][14][15] and significant correlations have been identified between timeresolved DCE-MR angiography and invasive prognostic indicators. However, the role of DCE-MR pulmonary vascular transit time (TT) measurements as prognostic markers in PAH has not yet been determined.…”

Section: Introductionmentioning

confidence: 99%

Dynamic Contrast–Enhanced Magnetic Resonance Imaging in Patients with Pulmonary Arterial Hypertension

et al. 2014

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Dynamic contrast-enhanced (DCE) time-resolved magnetic resonance (MR) imaging is a technique whereby the passage of an intravenous contrast bolus can be tracked through the pulmonary vascular system. The aim of this study was to investigate the prognostic significance of DCE-MR pulmonary blood transit times in patients with pulmonary arterial hypertension (PAH). Seventy-nine patients diagnosed with PAH underwent pulmonary DCE imaging at 1.5 T using a time-resolved three-dimensional spoiled gradient echo sequence. The prognostic significance of two DCE parameters, full width at half maximum (FWHM) of the first-pass clearance curve and pulmonary transit time (PTT), along with demographic and invasive catheter measurements, was evaluated by univariate and bivariate Cox proportional hazards regression and Kaplan-Meier analysis. DCE-MR transit times were most closely correlated with cardiac index (CI) and pulmonary vascular resistance index (PVRI) and were both found to be accurate for detecting reduced CI (FWHM area under the curve [AUC] at receiver operating characteristic analysis = 0.91 and PTT AUC = 0.92, respectively) and for detecting elevated PVRI (FWHM AUC = 0.88 and PTT AUC = 0.84, respectively). During the follow-up period, 25 patients died. Patients with longer measurements of FWHM (P = 0.0014) and PTT (P = 0.004) were associated with poor outcome at Kaplan-Meier analysis, and both parameters were strong predictors of adverse outcome from Cox proportional hazards analysis (P = 0.013 and 0.010, respectively). At bivariate analysis, DCE measurements predicted mortality independent of age, gender, and World Health Organization functional class; however, invasive hemodynamic indexes CI, PVRI, and DCE measurements were not independent of one another. In conclusion, DCE-MR transit times predict mortality in patients with PAH and are closely associated with clinical gold standards CI and PVRI.

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“…1). In normal subjects, this is about 6.8 ± 1.7 s [6]. In patients with pulmonary hypertension or congestive heart failure (CHF), pulmonary circulation can be slow and PTT will be prolonged, which may lead to delayed contrast arrival in the non target vessel, e.g.…”

Section: Normal Circulationmentioning

confidence: 99%

Contrast opacification on thoracic CT angiography: challenges and solutions

et al. 2016

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Contrast flow and enhancement patterns seen on thoracic CT angiography (CTA) can often be challenging and may often reveal more than is immediately apparent. A non-diagnostic CTA following the initial contrast injection can be secondary to many causes; these include both extrinsic factors, such as injection technique/equipment failure (iv cannula, power injector), and intrinsic, patient-related factors. Contrast pressure and flow graphs often contain useful information regarding the etiology of a non-diagnostic scan. Understanding these graphs will help the radiologist plan a repeat contrast injection to overcome the deficiencies of the first injection and thus obtain a diagnostic scan. The current review article outlines normal and abnormal intravenous contrast dynamics, discusses how to recognize etiologies of non-diagnostic scans, and ultimately addresses techniques to overcome obstacles towards obtaining normal contrast opacification of the target vessel. In addition, there are some life-threatening findings, which unless sought for, may remain hidden in plain sight. Key Points • Using contrast enhancement and flow patterns to identify the cause of a non-diagnostic CTA.• Recognize life threatening causes of altered contrast dynamics such as cardiac asystole.• Non-target vessel opacification may hold key to underlying pathophysiology.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-016-0524-3) contains supplementary material, which is available to authorized users.

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Measurement of Pulmonary Circulation Parameters Using Time-Resolved MR Angiography in Patients After Ross Procedure

Cited by 22 publications

References 19 publications

Time‐resolved magnetic resonance angiography: Evaluation of intrapulmonary circulation parameters in pulmonary arterial hypertension

Time‐resolved magnetic resonance angiography: Evaluation of intrapulmonary circulation parameters in pulmonary arterial hypertension

Dynamic Contrast–Enhanced Magnetic Resonance Imaging in Patients with Pulmonary Arterial Hypertension

Contrast opacification on thoracic CT angiography: challenges and solutions

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