Evaluation of 3T magnetic resonance imaging in paediatric patients with congenital or acquired heart disease – past experience of almost 1000 cases

Abstract

During the last decade magnetic resonance imaging (MRI) has emerged with credit from advances in the underlying technology, making it an inherent part of cardiac, non-invasive diagnostics. In the area of paediatric cardiology the comprehensive evaluation of 3 Tesla (3T) magnetic resonance imaging in paediatric patients with congenital or acquired heart disease is still pending. Here we demonstrate our efforts to adapt this technique to paediatric demands, with special focus on dispensability of further invasive methods subsequent to MRI. Since mid 2008 we applied MRI in approximately 1000 cases of our paediatric heart centre, aging from 1 day to 61 years of age and varying in weight from 1.7 to 109kg. More than 350 patients needed sedation, nearly 20 cases demanded intensive care treatment with ventilation-support during the examination. The underlying rational for the performance of MRI analysis in the majority of patients was routine control for evaluation of haemodynamics, heart function and morphology. All patients profited from MRI performance (TABLE1): In 96 patients the MRI rendered additional heart-catheterisation (HC) obsolete. Furthermore, although indications for interventional catheters remain unquestioned by MRI, in 150 patients the indicated HC could be shortened due to advance information by MRI analysis, lowering exposition towards contrast agent and radiation. Background question/diagnosis in most MRI performances (TABLE2) were addressed to the major heartvessels aorta and pulmonary artery diseases. In 58 cases of corrected tetrology of fallot (TOF) volumetric-ventricle- and pulmonary-artery-flow-analysis were helpful to indicate re-operation. Taken together our past experience of almost 1000 cases, the 3T MRI is a valuable and according to our experience an essential diagnostic tool for evaluation of myocardial function and morphology in paediatric patients, allowing a non-invasive, non-radiation-afflicted modus of examination.