HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, Z. J. Articles by Higgins, C. B. Search for Related Content PubMed PubMed Citation Articles by Wang, Z. J. Articles by Higgins, C. B. Related Collections Magnetic Resonance Imaging Cardiac Radiology

Cardiovascular Shunts: MR Imaging Evaluation¹

¹ From the Department of Radiology, Box 0628, University of California, 505 Parnassus Ave, San Francisco, CA 94143-0628. Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received February 3, 2003; revision requested March 20 and received May 1; accepted May 20. Address correspondence to G.P.R. (e-mail: gautham.reddy@radiology.ucsf.edu).

View larger version (161K): [in a new window]   Figure 1a.  Sinus venosus atrial septal defect in a 50-year-old woman with dyspnea on exertion. Axial ECG-gated spin-echo (a) and cine (b) MR images show a defect (arrow) in the portion of the atrial septum between the superior vena cava (SVC) and the left atrium (LA). Ao = ascending aorta, PA = main pulmonary artery.

View larger version (133K): [in a new window]   Figure 1b.  Sinus venosus atrial septal defect in a 50-year-old woman with dyspnea on exertion. Axial ECG-gated spin-echo (a) and cine (b) MR images show a defect (arrow) in the portion of the atrial septum between the superior vena cava (SVC) and the left atrium (LA). Ao = ascending aorta, PA = main pulmonary artery.

View larger version (142K): [in a new window]   Figure 2.  Atrial septal defect in the septum secundum in a 23-year-old man with a heart murmur. Axial ECG-gated spin-echo image shows a defect (arrow) in the middle of the septum and thickening (*) at the edge of the septum adjacent to the defect. LA = left atrium, RA = right atrium.

View larger version (173K): [in a new window]   Figure 3.  Atrial septal defect in the septum secundum in a 45-year-old man with dyspnea on exertion. Axial ECG-gated cine MR image shows a defect (arrow) in the middle of the atrial septum. LA = left atrium, RA = right atrium.

View larger version (150K): [in a new window]   Figure 4.  Normal atrial septum. Axial ECG-gated spin-echo image shows little signal intensity in the region of the fossa ovalis, in the interatrial septum (arrow)—a finding that could lead to a false-positive identification of atrial septal defect in the septum secundum.

View larger version (121K): [in a new window]   Figure 5a.  Eisenmenger syndrome in a 36-year-old woman. Axial ECG-gated spin-echo images show atrial septal defect (arrow in a) and marked enlargement of the main pulmonary artery (PA) (b), consistent with pulmonary arterial hypertension. Long-standing severe pulmonary arterial hypertension can result in the shunt reversal that characterizes Eisenmenger syndrome. Ao = ascending aorta, LA = left atrium, RA = right atrium.

View larger version (129K): [in a new window]   Figure 5b.  Eisenmenger syndrome in a 36-year-old woman. Axial ECG-gated spin-echo images show atrial septal defect (arrow in a) and marked enlargement of the main pulmonary artery (PA) (b), consistent with pulmonary arterial hypertension. Long-standing severe pulmonary arterial hypertension can result in the shunt reversal that characterizes Eisenmenger syndrome. Ao = ascending aorta, LA = left atrium, RA = right atrium.

View larger version (156K): [in a new window]   Figure 6a.  Membranous ventricular septal defect in an 11-month-old boy with a heart murmur. (a) Axial ECG-gated spin-echo image shows a defect (arrow) in the membranous part of the septum. (b) Axial gradient-echo cine image shows a flow jet (*) across the defect into the right ventricle, indicating a left-to-right shunt.

View larger version (160K): [in a new window]   Figure 6b.  Membranous ventricular septal defect in an 11-month-old boy with a heart murmur. (a) Axial ECG-gated spin-echo image shows a defect (arrow) in the membranous part of the septum. (b) Axial gradient-echo cine image shows a flow jet (*) across the defect into the right ventricle, indicating a left-to-right shunt.

View larger version (159K): [in a new window]   Figure 7.  Membranous ventricular septal defect in a 24-year-old man with tetralogy of Fallot. Coronal ECG-gated cine MR image shows a membranous ventricular septal defect (arrow) with an overriding aorta (Ao). (Courtesy of James Scatliff, MD, Department of Radiology, University of North Carolina, Chapel Hill)

View larger version (158K): [in a new window]   Figure 8a.  Supracristal ventricular septal defect in an asymptomatic 42-year-old man with a systolic murmur. (a) Axial ECG-gated spin-echo image shows a defect (arrow) between the base of the aorta and the right ventricular (RV) infundibulum. (b) Axial gradient-echo systolic cine image shows a flow jet (*) from the left ventricle into the right ventricular outflow tract, indicating a left-to-right shunt. (c) Sagittal spin-echo image shows a prolapse (arrow) of the posterior aortic sinus of Valsalva.

View larger version (167K): [in a new window]   Figure 8b.  Supracristal ventricular septal defect in an asymptomatic 42-year-old man with a systolic murmur. (a) Axial ECG-gated spin-echo image shows a defect (arrow) between the base of the aorta and the right ventricular (RV) infundibulum. (b) Axial gradient-echo systolic cine image shows a flow jet (*) from the left ventricle into the right ventricular outflow tract, indicating a left-to-right shunt. (c) Sagittal spin-echo image shows a prolapse (arrow) of the posterior aortic sinus of Valsalva.

View larger version (176K): [in a new window]   Figure 8c.  Supracristal ventricular septal defect in an asymptomatic 42-year-old man with a systolic murmur. (a) Axial ECG-gated spin-echo image shows a defect (arrow) between the base of the aorta and the right ventricular (RV) infundibulum. (b) Axial gradient-echo systolic cine image shows a flow jet (*) from the left ventricle into the right ventricular outflow tract, indicating a left-to-right shunt. (c) Sagittal spin-echo image shows a prolapse (arrow) of the posterior aortic sinus of Valsalva.

View larger version (165K): [in a new window]   Figure 9.  Atrioventricular septal defect. Axial ECG-gated spin-echo image shows an atrial septal defect (arrow) in the septum primum. The atrioventricular valve (arrowhead) is connected with the crest of the inlet ventricular septum. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

View larger version (171K): [in a new window]   Figure 10.  Atrioventricular septal defect. Axial ECG-gated spin-echo image shows a complete atrioventricular septal defect with communication among all four chambers, as well as a large inlet ventricular septal defect (arrow). The single atrioventricular valve (arrowheads) spans both ventricular chambers.

View larger version (142K): [in a new window]   Figure 11a.  Atrioventricular septal defect in a 2-year-old girl. Axial ECG-gated spin-echo MR images show an atrial septal defect (arrow in a) in the septum primum and an inlet ventricular septal defect (arrow in b), which together produce communication among all four chambers. The right atrium (RA) is markedly enlarged and the right ventricle (*) is hypoplastic. LA = left atrium, LV = left ventricle.

View larger version (148K): [in a new window]   Figure 11b.  Atrioventricular septal defect in a 2-year-old girl. Axial ECG-gated spin-echo MR images show an atrial septal defect (arrow in a) in the septum primum and an inlet ventricular septal defect (arrow in b), which together produce communication among all four chambers. The right atrium (RA) is markedly enlarged and the right ventricle (*) is hypoplastic. LA = left atrium, LV = left ventricle.

View larger version (172K): [in a new window]   Figure 12a.  Patent ductus arteriosus in a 46-year-old woman with a heart murmur. (a) Gadolinium-enhanced MR angiographic image shows a patent ductus (arrow) connecting the proximal descending aorta (dAo) to the left pulmonary artery (LPA), just beyond the pulmonary arterial bifurcation. Note the focal dilatation of the aorta at the site of ductal attachment. (b, c) Axial (b) and oblique (c) MR angiographic images also depict the ductus (arrow). aAo = ascending aorta. (Courtesy of Ruth Carlos, MD, Department of Radiology, University of Michigan, Ann Arbor)

View larger version (125K): [in a new window]   Figure 12b.  Patent ductus arteriosus in a 46-year-old woman with a heart murmur. (a) Gadolinium-enhanced MR angiographic image shows a patent ductus (arrow) connecting the proximal descending aorta (dAo) to the left pulmonary artery (LPA), just beyond the pulmonary arterial bifurcation. Note the focal dilatation of the aorta at the site of ductal attachment. (b, c) Axial (b) and oblique (c) MR angiographic images also depict the ductus (arrow). aAo = ascending aorta. (Courtesy of Ruth Carlos, MD, Department of Radiology, University of Michigan, Ann Arbor)

View larger version (151K): [in a new window]   Figure 12c.  Patent ductus arteriosus in a 46-year-old woman with a heart murmur. (a) Gadolinium-enhanced MR angiographic image shows a patent ductus (arrow) connecting the proximal descending aorta (dAo) to the left pulmonary artery (LPA), just beyond the pulmonary arterial bifurcation. Note the focal dilatation of the aorta at the site of ductal attachment. (b, c) Axial (b) and oblique (c) MR angiographic images also depict the ductus (arrow). aAo = ascending aorta. (Courtesy of Ruth Carlos, MD, Department of Radiology, University of Michigan, Ann Arbor)

View larger version (154K): [in a new window]   Figure 13a.  Aortopulmonary window in a 20-year-old woman. Axial (a) and coronal (b) ECG-gated spin-echo images show a large defect (double arrow) between the lateral aspect of the ascending aorta (Ao) and the medial aspect of the main pulmonary artery (PA).

View larger version (157K): [in a new window]   Figure 13b.  Aortopulmonary window in a 20-year-old woman. Axial (a) and coronal (b) ECG-gated spin-echo images show a large defect (double arrow) between the lateral aspect of the ascending aorta (Ao) and the medial aspect of the main pulmonary artery (PA).

View larger version (149K): [in a new window]   Figure 14a.  PAPVR in a 64-year-old woman. (a, b) Axial (a) and coronal (b) ECG-gated spin-echo images show drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava (SVC). Note the enlarged pulmonary artery (PA) in a, consistent with pulmonary arterial hypertension. (c) Axial spin-echo image at a lower level shows an associated atrial septal defect (arrow) in the sinus venosus. (d) Coronal gadolinium-enhanced MR angiographic image again shows drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava. The right upper lobe pulmonary vein is the most common anomalous vein. Ao = aorta, LA = left atrium.

View larger version (146K): [in a new window]   Figure 14b.  PAPVR in a 64-year-old woman. (a, b) Axial (a) and coronal (b) ECG-gated spin-echo images show drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava (SVC). Note the enlarged pulmonary artery (PA) in a, consistent with pulmonary arterial hypertension. (c) Axial spin-echo image at a lower level shows an associated atrial septal defect (arrow) in the sinus venosus. (d) Coronal gadolinium-enhanced MR angiographic image again shows drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava. The right upper lobe pulmonary vein is the most common anomalous vein. Ao = aorta, LA = left atrium.

View larger version (140K): [in a new window]   Figure 14c.  PAPVR in a 64-year-old woman. (a, b) Axial (a) and coronal (b) ECG-gated spin-echo images show drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava (SVC). Note the enlarged pulmonary artery (PA) in a, consistent with pulmonary arterial hypertension. (c) Axial spin-echo image at a lower level shows an associated atrial septal defect (arrow) in the sinus venosus. (d) Coronal gadolinium-enhanced MR angiographic image again shows drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava. The right upper lobe pulmonary vein is the most common anomalous vein. Ao = aorta, LA = left atrium.

View larger version (147K): [in a new window]   Figure 14d.  PAPVR in a 64-year-old woman. (a, b) Axial (a) and coronal (b) ECG-gated spin-echo images show drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava (SVC). Note the enlarged pulmonary artery (PA) in a, consistent with pulmonary arterial hypertension. (c) Axial spin-echo image at a lower level shows an associated atrial septal defect (arrow) in the sinus venosus. (d) Coronal gadolinium-enhanced MR angiographic image again shows drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava. The right upper lobe pulmonary vein is the most common anomalous vein. Ao = aorta, LA = left atrium.

View larger version (173K): [in a new window]   Figure 15.  PAPVR in a 71-year-old man with pulmonary arterial hypertension in whom no intracardiac shunt was found at echocardiography. Maximum-intensity projection image from MR angiographic data shows drainage of the right upper lobe pulmonary vein (arrow) into the superior vena cava.

View larger version (164K): [in a new window]   Figure 17.  PAPVR in a 43-year-old woman with dyspnea on exertion. Volume-rendered contrast-enhanced MR angiographic image shows drainage of the left upper lobe pulmonary vein (*) into the left vertical vein (+), and eventually into the superior vena cava ().

View larger version (165K): [in a new window]   Figure 16.  PAPVR in a 45-year-old woman with hypogenetic lung syndrome (scimitar syndrome). Volume-rendered contrast-enhanced MR angiographic image shows drainage of the right upper lobe pulmonary vein (arrow) into the inferior vena cava at its junction with the right atrium (RA). This syndrome involves a combination of various defects, which may include hypoplasia of the right lung and the right pulmonary artery (not shown).

View larger version (152K): [in a new window]   Figure 18.  Magnitude (top row) and phase (bottom row) images of the pulmonary artery (left column) and aorta (right column). Flow volume is calculated as the product of the mean flow velocity, which is measured on the phase images, and the cross-sectional area of the vessel. Flow in the pulmonary artery (PA) is equivalent to the right ventricular stroke volume (RVSV), and flow in the aorta is equivalent to the left ventricular stroke volume (LVSV).

View larger version (23K): [in a new window]   Figure 19.  Velocity-versus-time curves for blood flow in the aorta and the pulmonary artery (PA). Each point on the curve represents the mean blood flow in the vessel at a particular phase of the cardiac cycle, and each value is derived from a separate velocity-encoded cine MR image. Shunt severity is expressed as the ratio of pulmonary flow (Qp) to systemic flow (Qs).