Morphological diagnosis of congenital and acquired heart disease by magnetic resonance imaging

Abstract

Since 1987, the authors have examined 60 patients (21 girls, 39 boys) with a variety of congenital and acquired heart disases by means of ECG-gated magnetic resonance imaging (MRI) using a multislice spin-echo technique. The patients' ages ranged from 10 days to 20 years (mean age 3.7 years), distributed as follows: 9 patients (15%)≤4 weeks; 26 (43.4%)>4 weeks≤1 year; 9 (15%)>1 year≤6 years; 14 (23.3%)>6 years ≤15 years; and 2(3.3%)>15 years≤20 years. In 4 cases the quality of the images on the first study were of no diagnostic value and so a second investigation took place. Thus, 60 studies could be analysed, and the findings were compared with the previous diagnoses made on the basis of echocadiography (n=60) and angiocardiography (n=47). The 66 anomalies of the vessels included 6 that had been misdiagnosed (2, small patent ductus arterious (PDA); 1, pulmonary sling; 2, palliative shunt; 1, aortopulmonary collaterals). Amendment of the previous diagnosis was achieved in 8 cases. In 1 case an aorticopulmonary window was first detected by MRI and in another, a recoarctation of the aorta. The extent of an aortic aneurysm could be defined and a dissection of the aortic wall excluded. In 5 cases MRI gave more information on the pulmonary vascular status. Among 19 atrial anomalies, the diagnosis of an ASD was not conclusive with the previous tests in 2 cases, MRI tailed to detect an ASD in 2 others. The diagnosis of partial anomalous pulmonary venous return was established by MRI. In one case of cor triatriatum MRI.gave additional information about the pulmonary vein connections. One supposed atrial tumour was recognized as a prominent Eustachian valve. There were a total of 35 ventricular anomalies. Two membranous ventricular septal defects (VSDs) were not detected by MRI. On three occasions MRI improved the diagnosis, in one patient with a double-inlet left ventricle and in two children with ventricular aneurysm. Amongst 12 other anomalies of miscellaneous types no misdiagnoses were made. In 3 instances an improved diagnosis was achieved by the MRI study. Although this was not a blind study, MRI proved to be superior to echocardiography and (in part) to angiocardiography for diagnosis of the vascular status in pulmonary vascular hypoplasia and anomalous pulmonary vein return. MRI is valuable in detecting coarctations and aneurysms and it is able to define segmental anatomy and to demarcate intra-and extracardiac tumours. This report gives evidence of MRI as a noninvasive technique that allows accurate diagnosis especially in complex heart disease, even in newborns and infants.