(Circulation. 1995;91:2955-2960.)
© 1995 American Heart Association, Inc.
Articles |
Assessment of Left-to-Right Intracardiac Shunting by Velocity-Encoded, Phase-Difference Magnetic Resonance Imaging
A Comparison With Oximetric and Indicator Dilution Techniques
From the Departments of Internal Medicine (Cardiovascular Division) (W.G.H., R.A.L., B.M.M., J.E.W., C.L., D.W., L.D.H., R.M.P.) and Radiology (H.F.L., D.P.P., R.M.P.), University of Texas Southwestern Medical Center at Dallas.
Correspondence to Ronald M. Peshock, MD, Mary Nell and Ralph B. Rogers Magnetic Resonance Center, University of Texas Southwestern Medical Center, 5801 Forest Park, Dallas, TX 75235-9085. E-mail Peshock@rad-rogers.swmed.edu.
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.
Key Words: magnetic resonance imaging • imaging • catheterization
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