DOI: 10.1148/rg.261055064
Cardiac MR Imaging Assessment Following Tetralogy of Fallot Repair1
Karen I. Norton, MD,
Carrie Tong, MD,
Ronald B. J. Glass, MD and
James C. Nielsen, MD
1 From the Departments of Radiology (K.I.N., C.T., R.B.J.G., J.C.N.) and Pediatric Cardiology (J.C.N.), Mount Sinai Hospital, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received March 17, 2005; revision requested April 27 and received June 1; accepted June 2. All authors have no financial relationships to disclose.
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Figure 1. Drawing illustrates TOF. LV = left ventricle, RV = right ventricle, VSD = ventricular septal defect. Both the consistent features and the variable features of this pathologic condition are listed at right.
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Figure 2. TOF in a 2-month-old boy. Frontal radiograph demonstrates a boot-shaped heart with an uplifted apex secondary to RV hypertrophy and a concave main pulmonary artery segment. The lungs appear to be undercirculated.
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Figure 3. Pulmonary atresia with VSD in a 6-year-old boy. Frontal radiograph reveals extensive lacy, reticular pulmonary markings secondary to systemic-to-pulmonary collateral flow to the lungs. A right-sided aortic arch (arrow) is also seen.
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Figure 4. Uncorrected pulmonary atresia with VSD in a male infant. Coronal maximum-intensity-projection (MIP) image demonstrates a large aorta–pulmonary artery collateral vessel (arrow).
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Figure 5. Axial SSFP image obtained in a 14-year-old girl with repaired TOF reveals an overriding aortic valve and a VSD patch (arrow).
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Figure 6. Axial oblique MIP image of the branch pulmonary arteries obtained in a 9-year-old boy with repaired TOF demonstrates severe long-segment narrowing of the right pulmonary artery (long arrow) and moderate narrowing (arrowhead) of the left pulmonary artery (LPA). Short arrows indicate branches of the pulmonary veins. Ao = aorta, MPA = main pulmonary artery.
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Figure 7a. Time-resolved imaging in a 7-year-old girl with repaired TOF. A set of 30 measurements was obtained at less than 1 second per volume, with a voxel size of 2.5 x 2.0 x 2.5 mm. (a) Coronal oblique MIP images. At the first dynamic (top left), peripheral stenosis (arrow) is seen in the right pulmonary artery. At the second dynamic (top right), severe obstruction at the level of a bioprosthetic pulmonary valve (arrowhead) is more clearly delineated. Note the perfusion of the right lung and the filling of the right pulmonary veins. The third dynamic (bottom) better demonstrates the aortic arch and right pulmonary veins. (b) Sagittal oblique MIP images obtained to evaluate the left pulmonary artery show peripheral stenosis (arrowhead) and aneurysmal dilatation (arrow) of the MPA. The third dynamic (bottom) demonstrates the left pulmonary veins, the aortic arch, and the thoracic and abdominal aorta. (c) Volume-rendered image (posterior view) from the same time-resolved data set (only one dynamic reconstructed) clearly depicts the pulmonary venous connections and aortic arch.
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Figure 7b. Time-resolved imaging in a 7-year-old girl with repaired TOF. A set of 30 measurements was obtained at less than 1 second per volume, with a voxel size of 2.5 x 2.0 x 2.5 mm. (a) Coronal oblique MIP images. At the first dynamic (top left), peripheral stenosis (arrow) is seen in the right pulmonary artery. At the second dynamic (top right), severe obstruction at the level of a bioprosthetic pulmonary valve (arrowhead) is more clearly delineated. Note the perfusion of the right lung and the filling of the right pulmonary veins. The third dynamic (bottom) better demonstrates the aortic arch and right pulmonary veins. (b) Sagittal oblique MIP images obtained to evaluate the left pulmonary artery show peripheral stenosis (arrowhead) and aneurysmal dilatation (arrow) of the MPA. The third dynamic (bottom) demonstrates the left pulmonary veins, the aortic arch, and the thoracic and abdominal aorta. (c) Volume-rendered image (posterior view) from the same time-resolved data set (only one dynamic reconstructed) clearly depicts the pulmonary venous connections and aortic arch.
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Figure 7c. Time-resolved imaging in a 7-year-old girl with repaired TOF. A set of 30 measurements was obtained at less than 1 second per volume, with a voxel size of 2.5 x 2.0 x 2.5 mm. (a) Coronal oblique MIP images. At the first dynamic (top left), peripheral stenosis (arrow) is seen in the right pulmonary artery. At the second dynamic (top right), severe obstruction at the level of a bioprosthetic pulmonary valve (arrowhead) is more clearly delineated. Note the perfusion of the right lung and the filling of the right pulmonary veins. The third dynamic (bottom) better demonstrates the aortic arch and right pulmonary veins. (b) Sagittal oblique MIP images obtained to evaluate the left pulmonary artery show peripheral stenosis (arrowhead) and aneurysmal dilatation (arrow) of the MPA. The third dynamic (bottom) demonstrates the left pulmonary veins, the aortic arch, and the thoracic and abdominal aorta. (c) Volume-rendered image (posterior view) from the same time-resolved data set (only one dynamic reconstructed) clearly depicts the pulmonary venous connections and aortic arch.
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Figure 8a. Phase-contrast imaging in a 14-year-old girl with repaired TOF and PR. (a) Magnitude image from a phase-contrast sequence shows the pulmonary artery (arrow) in cross section. (b) On a phase-velocity image obtained during systole, the signal intensity of the pulmonary artery (arrow) is proportional to through-plane velocity. (c) Phase-velocity image obtained during diastole reveals retrograde PR flow (arrow). (d) Graph illustrates flow (in milliliters per second) versus time (in milliseconds) during phase-contrast imaging. PR is the ratio of retrograde flow volume (regurgitation) (dark gray) to antegrade flow volume (light gray). Both volumes are measured in milliliters.
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Figure 8b. Phase-contrast imaging in a 14-year-old girl with repaired TOF and PR. (a) Magnitude image from a phase-contrast sequence shows the pulmonary artery (arrow) in cross section. (b) On a phase-velocity image obtained during systole, the signal intensity of the pulmonary artery (arrow) is proportional to through-plane velocity. (c) Phase-velocity image obtained during diastole reveals retrograde PR flow (arrow). (d) Graph illustrates flow (in milliliters per second) versus time (in milliseconds) during phase-contrast imaging. PR is the ratio of retrograde flow volume (regurgitation) (dark gray) to antegrade flow volume (light gray). Both volumes are measured in milliliters.
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Figure 8c. Phase-contrast imaging in a 14-year-old girl with repaired TOF and PR. (a) Magnitude image from a phase-contrast sequence shows the pulmonary artery (arrow) in cross section. (b) On a phase-velocity image obtained during systole, the signal intensity of the pulmonary artery (arrow) is proportional to through-plane velocity. (c) Phase-velocity image obtained during diastole reveals retrograde PR flow (arrow). (d) Graph illustrates flow (in milliliters per second) versus time (in milliseconds) during phase-contrast imaging. PR is the ratio of retrograde flow volume (regurgitation) (dark gray) to antegrade flow volume (light gray). Both volumes are measured in milliliters.
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Figure 8d. Phase-contrast imaging in a 14-year-old girl with repaired TOF and PR. (a) Magnitude image from a phase-contrast sequence shows the pulmonary artery (arrow) in cross section. (b) On a phase-velocity image obtained during systole, the signal intensity of the pulmonary artery (arrow) is proportional to through-plane velocity. (c) Phase-velocity image obtained during diastole reveals retrograde PR flow (arrow). (d) Graph illustrates flow (in milliliters per second) versus time (in milliseconds) during phase-contrast imaging. PR is the ratio of retrograde flow volume (regurgitation) (dark gray) to antegrade flow volume (light gray). Both volumes are measured in milliliters.
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Figure 9a. FSE-DIR imaging versus SSFP imaging in an 18-year-old man with repaired TOF. (a) Axial FSE-DIR image obtained at the level of the branch pulmonary arteries reveals stenosis of the mid–right pulmonary artery (long arrow). Artifact from a stent in the left pulmonary artery is also seen (short arrow) but is less prominent than with gradient echo–based sequences. (b) MIP image reveals signal intensity loss in the left pulmonary artery secondary to the metallic stent. Prox = proximal.
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Figure 9b. FSE-DIR imaging versus SSFP imaging in an 18-year-old man with repaired TOF. (a) Axial FSE-DIR image obtained at the level of the branch pulmonary arteries reveals stenosis of the mid–right pulmonary artery (long arrow). Artifact from a stent in the left pulmonary artery is also seen (short arrow) but is less prominent than with gradient echo–based sequences. (b) MIP image reveals signal intensity loss in the left pulmonary artery secondary to the metallic stent. Prox = proximal.
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Figure 10a. Calculation of end-diastolic volume and end-systolic volume. (a) Multiple contiguous short-axis SSFP images show the endocardial borders of the ventricular cavities. (b) Magnified view of a short-axis SSFP image shows the calculated end-diastolic areas of the right (dark gray) and left (light gray) ventricles. Because the section thickness is known, the end-diastolic volume for each section can be calculated. The total end-diastolic volume can then be obtained by summing the volumes for contiguous sections. (c) Drawing illustrates the ventricular volume for an idealized right ventricle.
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Figure 10b. Calculation of end-diastolic volume and end-systolic volume. (a) Multiple contiguous short-axis SSFP images show the endocardial borders of the ventricular cavities. (b) Magnified view of a short-axis SSFP image shows the calculated end-diastolic areas of the right (dark gray) and left (light gray) ventricles. Because the section thickness is known, the end-diastolic volume for each section can be calculated. The total end-diastolic volume can then be obtained by summing the volumes for contiguous sections. (c) Drawing illustrates the ventricular volume for an idealized right ventricle.
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Figure 10c. Calculation of end-diastolic volume and end-systolic volume. (a) Multiple contiguous short-axis SSFP images show the endocardial borders of the ventricular cavities. (b) Magnified view of a short-axis SSFP image shows the calculated end-diastolic areas of the right (dark gray) and left (light gray) ventricles. Because the section thickness is known, the end-diastolic volume for each section can be calculated. The total end-diastolic volume can then be obtained by summing the volumes for contiguous sections. (c) Drawing illustrates the ventricular volume for an idealized right ventricle.
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Figure 11a. Measurement of RV size and function with cardiac MR imaging. (a) SSFP image shows a normal RV. (b) SSFP image obtained in a 14-year-old boy with repaired TOF shows a dilated RV.
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Figure 11b. Measurement of RV size and function with cardiac MR imaging. (a) SSFP image shows a normal RV. (b) SSFP image obtained in a 14-year-old boy with repaired TOF shows a dilated RV.
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Figure 12. Pulmonary stenosis in a 12-year-old boy with repaired TOF. Volume-rendered image (superior view) shows a dilated infundibulum, some narrowing at the pulmonary valve level, and mild bilateral branch pulmonary stenosis (arrows).
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Figure 13. RV outflow tract aneurysm in a 10-year-old girl with repaired TOF. Short-axis SSFP image reveals aneurysmal dilatation of the RV outflow tract (arrow). Significant dyskinesia was noted at cine MR imaging.
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Figure 14a. Conduit obstruction in a 25-year-old man with repaired TOF. (a) MIP image of an RV–pulmonary artery conduit suggests narrowing at the anastomosis (arrow). However, the image is degraded by artifact from metallic material within the conduit. (b) On a 2D FSE-DIR image, the narrowing (arrow) is still evident but is not as severe as was suggested by findings at bright (white) blood imaging.
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Figure 14b. Conduit obstruction in a 25-year-old man with repaired TOF. (a) MIP image of an RV–pulmonary artery conduit suggests narrowing at the anastomosis (arrow). However, the image is degraded by artifact from metallic material within the conduit. (b) On a 2D FSE-DIR image, the narrowing (arrow) is still evident but is not as severe as was suggested by findings at bright (white) blood imaging.
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Copyright © 2006 by the Radiological Society of North America.
