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Comparison between phase-velocity cine magnetic resonance imaging and invasive oximetry for quantification of atrial shunts

      Measurement of the pulmonary-to-systemic blood flow ratio (Qp/Qs) in patients with congenital heart disease and shunting lesions may be useful for determining the need for intervention or assessing outcome postprocedure. Frequently used methods to calculate Qp/Qs, such as invasive oximetry, first-pass radionuclide angiography, and Doppler echocardiography have limitations.
      • Boehrer J.D.
      • Lange R.A.
      • Willard J.E.
      • Grayburn P.A.
      • Hillis L.D.
      Advantages and limitations of methods to detect, localize, and quantitate intracardiac left-to-right shunting.
      Phase-velocity cine magnetic resonance imaging (PVC MRI) is a noninvasive technique to measure blood flow that has been demonstrated to be accurate in vitro and in vivo.
      • Firmin D.N.
      • Nayler G.L.
      • Klipstein R.H.
      • Underwood S.R.
      • Rees R.S.
      • Longmore D.B.
      In vivo validation of MR velocity imaging.
      ,
      • Powell A.J.
      • Maier S.E.
      • Chung T.
      • Geva T.
      Phase-velocity cine magnetic resonance imaging measurement of pulsatile blood flow in children and young adults in vitro and in vivo validation.
      ,
      • Evans A.J.
      • Iwai F.
      • Grist T.A.
      • Sostman H.D.
      • Hedlund L.W.
      • Spritzer C.E.
      • Negro-Vilar R.
      • Beam C.A.
      • Pelc N.J.
      Magnetic resonance imaging of blood flow with a phase subtraction technique. In vitro and in vivo validation.
      ,
      • Frayne R.
      • Steinman D.A.
      • Ethier C.R.
      • Rutt B.K.
      Accuracy of MR phase contrast velocity measurements for unsteady flow.
      ,

      Kondo C, Caputo GR, Semelka R, Foster E, Shimakawa A, Higgins CB. Right and left ventricular stroke volume measurements with velocity-encoded cine MR imaging: in vitro and in vivo validation. Am J Roentgenol 157:9–16

      We have previously reported that subjects without a shunt (n = 20) had a mean Qp/Qs of 0.99 ± 0.10 by PVC MRI.
      • Powell A.J.
      • Maier S.E.
      • Chung T.
      • Geva T.
      Phase-velocity cine magnetic resonance imaging measurement of pulsatile blood flow in children and young adults in vitro and in vivo validation.
      The aim of this study was to prospectively evaluate the accuracy, reproducibility, and interobserver variability of PVC MRI measurements of Qp/Qs in subjects with a known shunt. Oximetry at catheterization was selected for comparison because this remains the most widely accepted clinical standard.
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