Magnetic resonance angiography demonstration of congenital heart disease in adults.

OBJECTIVE: There are limitations when using spin-echo MR imaging to evaluate congenital heart disease (CHD). These include limited ability to detect small shunts, long acquisition times, in-plane or slow flow signal and limited ability to represent complicated three-dimensional (3D) anatomy. However, MR angiography can image flow direction and disturbances, assess function and easily represents 3D anatomy. This may be valuable when evaluating adults with CHD.

PATIENTS AND METHODS: Fifty consecutive adult patients were referred for MR evaluation of possible or known CHD using time-of-flight MR angiography. Cine, breathhold and presaturation cine MR angiography were acquired as appropriate, with 3D (MIP) reconstruction of all extracardiac anomalies.

RESULTS: Forty-nine patients had a diagnostic examination (one was unsatisfactory because of arrhythmia). Correlation with alternative imaging (TTE = 36, TOE = 13, cardiac catheter = 16) or surgery was available in 39 patients (MR angiography correct in 36 patients). MRA demonstrated or excluded all confirmed congenital valve (12/12), aortic (9/9), and venous (7/7) anomalies. Thirty-five patients were evaluated for shunts. MR angiography detected 31/33 confirmed shunts (shunts present in 26 patients, sensitivity 94%, specificity 95%). Although not used in all cases, spin-echo was unreliable in demonstrating shunts as signal loss in the region of the secundum septum frequently mimicked atrial septal defects (reducing accuracy for excluding intracardiac shunts, specificity 58%).

CONCLUSION: MR angiography accurately defines intra- and extra-cardiac anatomy and is superior to spin-echo in detecting or excluding shunts. MR angiography safely and accurately demonstrates many aspects of CHD in adults.