Key result
MDCT imaging in the prone position eliminated the appearance of >50% pulmonary vein pseudostenosis that was observed in 9% (11/116) of patients when imaged in the supine position.
Why the study?
Does MDCT image acquisition in the prone position compared to the supine position improve the detection of true pulmonary vein stenosis by eliminating pseudostenosis in patients undergoing PVI?
Cross-Sectional (n=116)
Single-blind
No
Does MDCT image acquisition in the prone position compared to the supine position improve the detection of true pulmonary vein stenosis by eliminating pseudostenosis in patients undergoing PVI?
Prone position MDCT is essential for differentiating true pulmonary vein stenosis from pseudostenosis caused by descending aorta compression in patients undergoing pulmonary vein isolation.
Prone MDCT may reduce pseudostenosis misclassification post-PVI; hypothesis-generating and should not yet alter imaging protocols.
BACKGROUND: Pulmonary vein (PV) stenosis is a major complication of PV isolation (PVI) by catheter ablation, so in the present study the optimal position for detecting PV stenosis on enhanced multidetector computed tomography (MDCT) image acquisition was determined. METHODS AND RESULTS: The 64-slice enhanced MDCT was carried out before and after PVI in 116 consecutive patients with atrial fibrillation while they were in the prone position, as well as while supine. The supine position MDCT image showed >50% diameter stenosis of the PV in 11 (9%) patients before PVI (% diameter stenosis: mean 55+/-4%, range 51-65%). Greater than 50% diameter stenosis was seen in the left inferior PV in all 11 patients. The prone position attenuated the PV stenosis findings in the MDCT images in all 11 patients (mean 9+/-6%, range 2-18%). Stenosis visualized on images acquired in the supine position was, therefore, concluded to be pseudostenosis caused by descending aorta compression. At 3 months after PVI, no significant changes in PV diameter were observed in these 11 patients. CONCLUSION: The present study demonstrated that the prone position is essential for eliminating PV pseudostenosis observed on supine-position enhanced MDCT images. The results also indicate that preexisting PV organic stenosis is rare.
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Yamaji et al. (2008) conducted a cross-sectional in Atrial Fibrillation (n=116). Prone position MDCT imaging vs. Supine position MDCT imaging was evaluated on Detection of >50% diameter stenosis of the pulmonary vein (pseudostenosis). MDCT imaging in the prone position eliminated the appearance of >50% pulmonary vein pseudostenosis that was observed in 9% (11/116) of patients when imaged in the supine position.
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