Assessment of left-to-right intracardiac shunting by velocity-encoded, phase-difference magnetic resonance imaging: A comparison with oximetric and indicator dilution techniques

W. G. Hundley, H. F. Li, R. A. Lange, Dennis P Pfeifer, B. M. Meshack, J. E. Willard, C. Landau, Duwayne L Willett, L. D. Hillis, Ronald M Peshock

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Background: Velocity-encoded, phase-difference magnetic resonance imaging (MRI) has been shown to provide an accurate assessment of shunt magnitude in patients with large atrial septal defects, but its ability to determine shunt magnitude in patients with intracardiac left-to-right shunts of various locations and sizes has not been evaluated in a prospective and blinded manner. The objective of the present study was to determine whether velocity- encoded, phase-difference MRI can assess the magnitude of intracardiac left- to-right shunting in humans. Methods and Results: Twenty-one subjects (15 women and 6 men; age range, 15 to 72 years) underwent velocity-encoded, phase-difference MRI measurements of flow in the proximal aorta and pulmonary artery, followed immediately by cardiac catheterization. The presence of left-to-right intracardiac shunting was assessed with hydrogen inhalation, after which shunt magnitude was measured by the oximetric and indocyanine green techniques. Of the 21 patients, 12 had left-to-right intracardiac shunting detected by hydrogen inhalation. There was a good correlation (r = .94) between the invasive and MRI assessments of shunt magnitude. In comparison to oximetry and indocyanine green, MRI correctly identified the 12 patients with a ratio of pulmonary to systemic flow (Qp/Qs) of <1.5 (9 without intracardiac shunting and 3 with small shunts) and the 9 patients with a Qp/Qs of ≥1.5 (6 with atrial septal defect, 1 with ventricular septal defect, 1 with patent ductus arteriosus, and 1 with both atrial septal defect and patent ductus arteriosus). Conclusions: Compared with measurements obtained during cardiac catheterization, velocity-encoded, phase-difference MRI measurements of flow in the proximal great vessels can reliably assess the magnitude of intracardiac left-to-right shunting.

Original languageEnglish (US)
Pages (from-to)2955-2960
Number of pages6
JournalCirculation
Volume91
Issue number12
StatePublished - 1995

Fingerprint

Indicator Dilution Techniques
Magnetic Resonance Imaging
Indocyanine Green
Patent Ductus Arteriosus
Atrial Heart Septal Defects
Cardiac Catheterization
Inhalation
Hydrogen
Oximetry
Ventricular Heart Septal Defects
Pulmonary Artery
Aorta
Lung

Keywords

  • catheterization
  • imaging
  • magnetic resonance imaging

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Assessment of left-to-right intracardiac shunting by velocity-encoded, phase-difference magnetic resonance imaging : A comparison with oximetric and indicator dilution techniques. / Hundley, W. G.; Li, H. F.; Lange, R. A.; Pfeifer, Dennis P; Meshack, B. M.; Willard, J. E.; Landau, C.; Willett, Duwayne L; Hillis, L. D.; Peshock, Ronald M.

In: Circulation, Vol. 91, No. 12, 1995, p. 2955-2960.

Research output: Contribution to journalArticle

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abstract = "Background: Velocity-encoded, phase-difference magnetic resonance imaging (MRI) has been shown to provide an accurate assessment of shunt magnitude in patients with large atrial septal defects, but its ability to determine shunt magnitude in patients with intracardiac left-to-right shunts of various locations and sizes has not been evaluated in a prospective and blinded manner. The objective of the present study was to determine whether velocity- encoded, phase-difference MRI can assess the magnitude of intracardiac left- to-right shunting in humans. Methods and Results: Twenty-one subjects (15 women and 6 men; age range, 15 to 72 years) underwent velocity-encoded, phase-difference MRI measurements of flow in the proximal aorta and pulmonary artery, followed immediately by cardiac catheterization. The presence of left-to-right intracardiac shunting was assessed with hydrogen inhalation, after which shunt magnitude was measured by the oximetric and indocyanine green techniques. Of the 21 patients, 12 had left-to-right intracardiac shunting detected by hydrogen inhalation. There was a good correlation (r = .94) between the invasive and MRI assessments of shunt magnitude. In comparison to oximetry and indocyanine green, MRI correctly identified the 12 patients with a ratio of pulmonary to systemic flow (Qp/Qs) of <1.5 (9 without intracardiac shunting and 3 with small shunts) and the 9 patients with a Qp/Qs of ≥1.5 (6 with atrial septal defect, 1 with ventricular septal defect, 1 with patent ductus arteriosus, and 1 with both atrial septal defect and patent ductus arteriosus). Conclusions: Compared with measurements obtained during cardiac catheterization, velocity-encoded, phase-difference MRI measurements of flow in the proximal great vessels can reliably assess the magnitude of intracardiac left-to-right shunting.",
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T2 - A comparison with oximetric and indicator dilution techniques

AU - Hundley, W. G.

AU - Li, H. F.

AU - Lange, R. A.

AU - Pfeifer, Dennis P

AU - Meshack, B. M.

AU - Willard, J. E.

AU - Landau, C.

AU - Willett, Duwayne L

AU - Hillis, L. D.

AU - Peshock, Ronald M

PY - 1995

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N2 - Background: Velocity-encoded, phase-difference magnetic resonance imaging (MRI) has been shown to provide an accurate assessment of shunt magnitude in patients with large atrial septal defects, but its ability to determine shunt magnitude in patients with intracardiac left-to-right shunts of various locations and sizes has not been evaluated in a prospective and blinded manner. The objective of the present study was to determine whether velocity- encoded, phase-difference MRI can assess the magnitude of intracardiac left- to-right shunting in humans. Methods and Results: Twenty-one subjects (15 women and 6 men; age range, 15 to 72 years) underwent velocity-encoded, phase-difference MRI measurements of flow in the proximal aorta and pulmonary artery, followed immediately by cardiac catheterization. The presence of left-to-right intracardiac shunting was assessed with hydrogen inhalation, after which shunt magnitude was measured by the oximetric and indocyanine green techniques. Of the 21 patients, 12 had left-to-right intracardiac shunting detected by hydrogen inhalation. There was a good correlation (r = .94) between the invasive and MRI assessments of shunt magnitude. In comparison to oximetry and indocyanine green, MRI correctly identified the 12 patients with a ratio of pulmonary to systemic flow (Qp/Qs) of <1.5 (9 without intracardiac shunting and 3 with small shunts) and the 9 patients with a Qp/Qs of ≥1.5 (6 with atrial septal defect, 1 with ventricular septal defect, 1 with patent ductus arteriosus, and 1 with both atrial septal defect and patent ductus arteriosus). Conclusions: Compared with measurements obtained during cardiac catheterization, velocity-encoded, phase-difference MRI measurements of flow in the proximal great vessels can reliably assess the magnitude of intracardiac left-to-right shunting.

AB - Background: Velocity-encoded, phase-difference magnetic resonance imaging (MRI) has been shown to provide an accurate assessment of shunt magnitude in patients with large atrial septal defects, but its ability to determine shunt magnitude in patients with intracardiac left-to-right shunts of various locations and sizes has not been evaluated in a prospective and blinded manner. The objective of the present study was to determine whether velocity- encoded, phase-difference MRI can assess the magnitude of intracardiac left- to-right shunting in humans. Methods and Results: Twenty-one subjects (15 women and 6 men; age range, 15 to 72 years) underwent velocity-encoded, phase-difference MRI measurements of flow in the proximal aorta and pulmonary artery, followed immediately by cardiac catheterization. The presence of left-to-right intracardiac shunting was assessed with hydrogen inhalation, after which shunt magnitude was measured by the oximetric and indocyanine green techniques. Of the 21 patients, 12 had left-to-right intracardiac shunting detected by hydrogen inhalation. There was a good correlation (r = .94) between the invasive and MRI assessments of shunt magnitude. In comparison to oximetry and indocyanine green, MRI correctly identified the 12 patients with a ratio of pulmonary to systemic flow (Qp/Qs) of <1.5 (9 without intracardiac shunting and 3 with small shunts) and the 9 patients with a Qp/Qs of ≥1.5 (6 with atrial septal defect, 1 with ventricular septal defect, 1 with patent ductus arteriosus, and 1 with both atrial septal defect and patent ductus arteriosus). Conclusions: Compared with measurements obtained during cardiac catheterization, velocity-encoded, phase-difference MRI measurements of flow in the proximal great vessels can reliably assess the magnitude of intracardiac left-to-right shunting.

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