Lymphatic pathway evaluation in congenital heart disease using 3D whole-heart balanced steady state free precession and T2-weighted cardiovascular magnetic resonance
| Autor: | Jeanne Dillenbeck, Joshua S. Greer, Zachary Blair, Gerald F. Greil, Daniel A. Castellanos, Sheena Pimplawar, Vasu Gooty, Surendranath R. Veeram Reddy, Yousef Arar, Riad Abou Zahr, Tarique Hussain |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
lcsh:Diseases of the circulatory (Cardiovascular) system medicine.medical_treatment 030204 cardiovascular system & hematology SSFP 030218 nuclear medicine & medical imaging 0302 clinical medicine Lymphatic imaging Child Interventional CMR Cardiac catheterization Radiological and Ultrasound Technology medicine.diagnostic_test Central venous pressure Cisterna chyli Lymphography Lymphatic intervention medicine.anatomical_structure Lymphatic system Child Preschool Single ventricle T2-weighted imaging Female Radiology Cardiology and Cardiovascular Medicine Adult Heart Defects Congenital medicine.medical_specialty Adolescent Thoracic duct Thoracic Duct 03 medical and health sciences Young Adult Imaging Three-Dimensional Magnetic resonance imaging Predictive Value of Tests Image Interpretation Computer-Assisted medicine Humans Radiology Nuclear Medicine and imaging Angiology Retrospective Studies Congenital heart disease business.industry Research Infant Reproducibility of Results Ventricle lcsh:RC666-701 business 3D-balanced SSFP |
| Zdroj: | Journal of Cardiovascular Magnetic Resonance, Vol 23, Iss 1, Pp 1-9 (2021) Journal of Cardiovascular Magnetic Resonance |
| Popis: | Background Due to passive blood flow in palliated single ventricle, central venous pressure increases chronically, ultimately impeding lymphatic drainage. Early visualization and treatment of these malformations is essential to reduce morbidity and mortality. Cardiovascular magnetic resonance (CMR) T2-weighted lymphangiography (T2w) is used for lymphatic assessment, but its low signal-to-noise ratio may result in incomplete visualization of thoracic duct pathway. 3D-balanced steady state free precession (3D-bSSFP) is commonly used to assess congenital cardiac disease anatomy. Here, we aimed to improve diagnostic imaging of thoracic duct pathway using 3D-bSSFP. Methods Patients underwent CMR during single ventricle or central lymphatic system assessment using T2w and 3D-bSSFP. T2w parameters included 3D-turbo spin echo (TSE), TE/TR = 600/2500 ms, resolution = 1 × 1 × 1.8 mm, respiratory triggering with bellows. 3D-bSSFP parameters included electrocardiogram triggering and diaphragm navigator, 1.6 mm isotropic resolution, TE/TR = 1.8/3.6 ms. Thoracic duct was identified independently in T2w and 3D-bSSFP images, tracked completely from cisterna chyli to its drainage site, and classified based on severity of lymphatic abnormalities. Results Forty-eight patients underwent CMR, 46 of whom were included in the study. Forty-five had congenital heart disease with single ventricle physiology. Median age at CMR was 4.3 year (range 0.9–35.1 year, IQR 2.4 year), and median weight was 14.4 kg (range, 7.9–112.9 kg, IQR 5.2 kg). Single ventricle with right dominant ventricle was noted in 31 patients. Thirty-eight patients (84%) were status post bidirectional Glenn and 7 (16%) were status post Fontan anastomosis. Thoracic duct visualization was achieved in 45 patients by T2w and 3D-bSSFP. Complete tracking to drainage site was attained in 11 patients (24%) by T2w vs 25 (54%) by 3D-bSSFP and in 28 (61%) by both. Classification of lymphatics was performed in 31 patients. Conclusion Thoracic duct pathway can be visualized by 3D-bSSFP combined with T2w lymphangiography. Cardiac triggering and respiratory navigation likely help retain lymphatic signal in the retrocardiac area by 3D-bSSFP. Visualizing lymphatic system leaks is challenging on 3D-bSSFP images alone, but 3D-bSSFP offers good visualization of duct anatomy and landmark structures to help plan interventions. Together, these sequences can define abnormal lymphatic pathway following single ventricle palliative surgery, thus guiding lymphatic interventional procedures. |
| Databáze: | OpenAIRE |
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