Clinical Study Of Combined MR Imaging In Determination Of Complex Congenital Heart Disease

##原图像无英文摘要内容 Background and objectiveThe congenital heart disease(CHD) exists in the form of all kinds of organic heart pathological change which formed prior to birth.It is reported that approximately 7%0,-8%0 of neonates in our country have CHD,and there are more than 40,000 operations for CHD every year, approximately 20%of the cases is complex congenital heart disease (CCHD).CCHD exists in the form of tetralogy of Fallot(TOF),doubleoutlet of rightventricle(DORV),transposition of the great arteries (TGA),single ventricle(SV) and other diseases with complex cardiovascular abnormalities.In the recent 10 years,surgical therapy of CCHD had the new progress.Cardiovascular abnormalities of CCHD are often multiple and serious,it has the important value for choosing the cases,making operative plan and evaluation of operation to comprehend the information about anatomy of abnormal,degree of severity,function of the heart and vascular growth.And it is also a subject of the imaging diagnosis.It was very hard to make a complete diagnosis of CCHD by other non-wound imaging examinations,and it often need X-ray Cardiac angiography.The imaging methods comprise cardiac magnetic resonance(CMR), ultrasonic cardiogram(UCG) and x-ray cardiac angiography(CAG). Cardiac magnetic resonance is more and more generally used in diagnosis of CHD.The reports on clinical study of combined MR imaging in determination of CCHD is less.In the study,we use combined MR imaging to determinate CCHD, mainly the morphous and function of heart which can supply most of the clinical requirement.We compare the diagnostic evaluation of CMR, UCG and ACG in patients with tetralogy of Fallot(TOF,which is most common and typical) before operation,and to evaluate the diagnostic value for complex congenital heart disease by using multimodality MR imaging.Materials and methodsForty-one patients with a diagnosis of complex congenital heart disease who underwent CMR,UCG and ACG were retrospectively reviewed.The imaging examinations were studied to assess their usefulness in providing information regarding the anatomic abnormalities.Cardiac MRI can combine multimodality MR imaging technique to provide anatomic and functional information,including Dark-blood, white-blood sequences,cine MR,Contrast enhanced MR angiography (CE-MRA).In general,the images obtained with a rigorous orientation along the body axes(axial plane for example) are indispensable for the topographic images of the cardiac,for the evaluation of the pericardium, of the aorta,of the anterior wall of the right ventricle,of the pulmonary veins,of the superior and inferior cava veins and for the study of the mediastinal space.A correct evaluation of heart morphology requires that the images be obtained according to oblique planes along the main axes of the heart.This involves the use of planes passing through the short axis of the left ventricle,and the long vertical and horizontal axes.Contrast enhanced dynamic MR imaging can provide information of blood flow and vessel and is helpful in demonstrating the cardiovascular abnormalities. Ultrasonic cardiogram(UCG) is used to observe the morphous,the internal structure and the connection relations of the heart and vascellum with multi-spots and multi-section.Doppler is used to observe the blood flow.X-ray cardiac angiography(CAG) is used to display morphous and the spatial arrangement relations of cardiac vessel with Selective right ventriculography.CMR findings of intracardiac abnormalities,nonpulmonary features, pulmonary abnormalities were compared with information obtained at UCG,ACG and at surgery.ResultsThere are 192 intracardiac abnormalities confirmed by surgery in 41 patients,CMR accurately diagnoses 171 of them(89.1%),while UCG 181 cases(94.8%),ACG 129 cases(84.9%) totally.Of 18 nonpulmonary extracardiac features,CMR accurately diagnoses 17 of them(94.4%),while UCG 5 cases(27.8%),ACG 12 cases(66.7%). In the pulmonary abnormalities,CMR got the accuracy of 100%(23/23), while UCG got 47.8%(11/23),ACG 73.9%(17/23).CMR,UCG and ACG all got a high accuracy in intracardiac abnormalities,UCG is the best.But in extracardiac abnormalities,especially pulmonary abnormalities,CMR is more excellent than UCG and ACG.ConclusionCMR,UCG and ACG both have advantages and limitations,in diagnosing cardiovascular diseases.The main abnormalities of complex congenital heart disease can be demonstrated well by CMR,UCG and ACG.But for the intracardiac abnormalities,UCG is the best method, which can provide information regarding blood and anatomic of valvular.