Cardiovascular MRI and CT in congenital heart disease

Figures

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  Figure 1. Balanced SSFP cine imaging in a patient with a dilated RVOT, pulmonary regurgitation and dilated RV post repair of tetralogy of Fallot (Video 1).

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  Figure 2. Two-dimensional black blood images of the right and left pulmonary arteries.

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  Figure 3. Contrast-enhanced MR angiography of the right ventricle and branch pulmonary arteries, and the pulmonary veins, left ventricle and aorta.

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  Figure 4. (A) 3D SSFP dataset, in coronal, axial and sagittal planes. (B) MPR of 3D SFFP image demonstrating measurement of the sinotubular junction of the aorta. This is measured in image B, from orthogonal planes (A and C).

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  Figure 5. Ventricular volumes are generated from a stack of 2D cine CMR slices across the ventricle.

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  Figure 6. CMRFT quantifying global longitudinal strain of the left ventricle.

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  Figure 7. Magnitude (A) and phase-contrast flow images (B) and flow map measurement using MR analysis software (C) (in this case the main pulmonary artery). The flow value is the area under the curve.

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  Figure 8. (A) Estimation of flow from a PDA. (B) Estimation of aortopulmonary Collateral flow in a Fontan.

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  Figure 9. 4D flow image of a patient with coarctation of aorta. The great vessels (pulmonary artery, PA and aorta, Ao) are annotated. The arrow points towards the coarctation. Flow acceleration is denoted in the flow velocity colour map as shown. (Image courtesy of Dr Francesca Raimondi, Hôpital Universitaire Necker – Enfants Malades, Paris, France.)

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  Figure 10. Late gadolinium enhancement images (LGE) of apical short axis, four-chamber and two-chamber view. LGE in the mid and apical inferior aspect of the LV. Infarcted area shows delayed gadolinium uptake (blue arrows pointing at the bright white structure). In this instance the effect is transmural. This corresponds to an invasive coronary angiogram finding of a thrombosed distal left anterior descending artery. The apical thrombus is also shown (red arrow).

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  Figure 11. Macroscopic fibrosis and correlation with in vivo late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in heart explanted during follow-up. LGE CMR (A and C) and corresponding photographs of macroscopic sections (B and D) showing excellent correlation of CMR LGE with visually fibrotic areas (arrows). The increased signal on balanced steady state free precession (E) and turbo spin echo (F; continuous arrows) is compatible with fat. In (G), the corresponding macroscopic specimen shows epicardial fatty infiltration (continuous arrows) but also right ventricular (RV) endocardial fibrosis. Corresponding histology is shown after staining with Masson’s Trichrome; region (H) shows extensive replacement of the compact myocardium by fatty tissue, whereas the trabeculations lining the cavity contain myocardium (red) and extensive fibrous tissue (green, ×16). Regions (I) and (J) show extensive fatty and fibrous replacement (×100). (B) Microscopic fibrosis and correlation with in vivo LGE CMR. Extensive RV LGE (A; short axis CMR plane) corresponded with macroscopic fibrosis in the explanted heart (B; transverse specimen) with Picrosirius Red staining confirmed collagen in…

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  Figure 12. Tumour characterisation using different MR techniques, of a cardiac fibroma. Top row: (A) 2D balanced SSFP cine iso-intense signal with the myocardium, (B) T1 black blood with no fat suppression showing heterogenous texture with hyper-intense signal of the tumour capsule compared to myocardium and skeletal muscle, and (C) T1 black blood with fat suppression suggests that the tumour is not comprised of fatty tissue. Middle row: (D) T2 turbo-spin-echo black blood, (E) first pass perfusion image with no enhancement of the tumour (dark, *) compared to normal myocardium (yellow arrows) suggesting a non-vascular nature, and (F), late gadolinium enhancement, with high signal (red arrows) with a low signal dark core (*). Bottom row: multiplanar reconstruction using 3D SSFP dataset to locate extent of the tumour within the heart. Coronal (G), axial (H) and sagittal (I) view of the heart with location of the cardiac tumour.