Mitchell Goldman

Cardiac magnetic resonance imaging in children with congenital heart disease.

Electrocardiogram-gated magnetic resonance imaging (MRI) was used to evaluate 36 children, ages 2 to 17 years, with congenital heart disease. With the use of multiple imaging planes, including transverse, sagittal, coronal, and 60-degree left anterior oblique views, high contrast images with excellent spatial resolution were produced. In 34 of the 36 patients the anatomic detail provided by MRI was sufficient to make the cardiac diagnosis. Electrocardiogram-gated MRI is an important new imaging technique for use in children with cardiovascular disease.

Tumor of the heart diagnosed by magnetic resonance imaging

A case of liposarcoma metastatic to the heart is presented. This is a very rare entity and only three prior case reports could be found. Magnetic resonance imaging was successfully used to visualize the tumor. These images compared favorably with a two-dimensional echocardiographic study and postmortem examination.

114 MAGNETIC RESONANCE IMAGING IN CHILDREN WITH CONGENITAL HEART DISEASE

Electrocardiographic (ECG)-gated magnetic resonance imaging (MRI) studies were done on 23 children ages 1-17 yrs. with a 0.6 Telsa super-conducting magnet using coronal, transverse, sagittal and left anterior oblique planes. A spin echo pulsing sequence with a 30 msec time to echo delay was used. Two dimensional sections 0.75cm-1.0cm thick were obtained with an average scanning time of 4 min per viewing plane. Diagnoses included: tetralogy of Fallot (10), atrial septal defect (5), ventricular septal defect (3), single atrium (1), transposition of great arteries (1), subaortic stenosis (1), Intracardiac tumor (2). All diagnoses were confirmed by cardiac catheterization and/or echocardiography. MRI studies gave precise, diagnostic visualization of cardiac malformations in 21/23 cases. The transverse view afforded excellent visualization of ventricular and atrial septal defects, main pulmonary artery and its branches. The coronal view demonstrated the aortic arch, right ventricular outflow and inflow tracts. The sagittal view delineated aortic arch and right ventricular outflow tract anatomy. The left anterior oblique view localized ventricular septal defects, aortic arch abnormalities and demonstrated aortic override in tetralogy of Fallot. In cardiac tumors, the size, location and extent of myo-cardial attachment was well delineated by MRI. In summary, MRI is a safe, accurate, non-invasive test which gives detailed information of cardiac anatomy in congenital heart disease.

83 MAGNETIC RESONANCE IMAGING STUDIES IN COARCTATION OF THE AORTA AND THE MARFAN SYNDROME

ECG-gated magnetic resonance imaging (MRI) studies were done on 8 children with coarctation (coarc) of the aorta (Ao), 2-17 yrs., and 8 patients (pts) with Marfan Syndrome (MF), 10-27 yrs. Multiple imaging planes were obtained using a 0.6T super-conducting magnet, and 0.75-1cm thick sections. In the coarc pts, 1 had MRI pre and post surgery, 1 had MRI pre and post balloon angioplasty (BA), 5 had MRI post BA and 1 had MRI pre BA. Precise visualization of the coarc was noted in the 2 pre therapy studies and in the BA pt the MRI coarc diameter correlated with the angiographic diameter. After therapy there was documentation of relief of the coarc on MRI; no aneuryms were seen in the BA pts. In MF, the Ao root, ascending Ao (Asc Ao), Ao arch and descending Ao (Desc Ao) were well delineated. All MF pts had dilation of the Ao root and Asc Ao: none had dilation of the Desc Ao. In both coarc and MF, the sagittal view gave best visualization of the Ao isthmus, Desc Ao and collaterals when present. Asc Ao and arch vessels were best seen on the left anterior oblique and coronal views. Thus, MRI gives excellent visualization of the Asc Ao, Ao arch, and Desc Ao comparable only to invasive angiography. In coarc, MRI allows accurate localization of site of coarc, and non-invasive follow up of treatment. In MF, MRI provides an excellent means of serial evaluation of the aorta.