Chest
Clinical InvestigationsDIFFUSE DISEASESDecreased Pulmonary Perfusion in Pulmonary Vein Stenosis After Radiofrequency Ablation: Assessment With Dynamic Magnetic Resonance Perfusion Imaging
Section snippets
Control Group
First, MR perfusion imaging was evaluated in a control group of 26 patients (mean [± SD] age, 62.3 ± 17.2 years) without any history or suspicion of pulmonary disease or pulmonary perfusion disorder (eg, embolism, pneumonia, malformation, or PVS). Indications for an MR examination in these patients were as follows: an evaluation of left ventricular aneurysm prior to cardiac surgery in 24 patients; and postoperative control after resection of left ventricular aneurysm in 2 patients. The MR
Results
All 51 patients enrolled for PV diameter reduction of > 25% from 110 patients examined after RFA completed the combined MR perfusion/MRA protocol as scheduled. Twelve of these patients developed a severe PVS or clinical symptoms, and therefore underwent PV dilatation and were controlled in 22 follow-up examinations.
MR Perfusion Imaging
MR pulmonary perfusion imaging proved to be reliable for the assessment of pulmonary perfusion, whereby areas of decreased perfusion were precisely matched in both MR perfusion imaging and SPECT perfusion imaging. MR perfusion imaging reached 95.2% sensitivity. Anatomic landmarks in MRI (pulmonary vessels and lobar fissures) and better spatial resolution compared to SPECT scanning eased the diagnosis. A higher contrast between normal and decreased perfusion compared to MRI is inherent to SPECT
Conclusion and Implications
The functional consequences of PVS have been underestimated until now. A combined “one-stop shopping” MRA and MR perfusion examination allowed the visualization of both PVS and subsequent perfusion defects. PVS below a cutoff value of approximately 6 mm invariably resulted in marked and extended perfusion deficits, which led to a reevaluation of the RFA and PV dilatation techniques.
While the mechanism underlying the slow perfusion recovery after PVS dilatation is not understood to date, a
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2018, Cardiovascular Magnetic Resonance: A Companion to Braunwald’s Heart DiseaseIdiopathic pulmonary vein thrombosis: An unexpected cause of respiratory distress and acute heart failure. A case report and review of the literature
2017, African Journal of Emergency MedicineCitation Excerpt :The latter, supplied by small side-branches of the coronary arteries, believed to modulate both myocardium and coronary arteries locally, and the occlusion of small coronary arteries can cause heart failure or worsen pre-existing chronic heart failure [15]. Second, in the presence of a PULMONARY VEIN THROMBOSIS, the drainage systems of both the pulmonary and bronchial circulations may be blocked, which can cause consequences, including alveolar haemorrhages, interstitial pulmonary oedema, pleural effusions, and alterations in pulmonary perfusion [16]. Such anomalies can contribute to disturbances in ventilation-perfusion, leading to hypoxaemia, which appeared to be the main factor that caused the acute decompensated heart failure in our case.
Pulmonary vein stenosis complicating radiofrequency catheter ablation for atrial fibrillation: A literature review
2016, Respiratory MedicineCitation Excerpt :Symptoms related to PVS typically occur with a reduction in lung perfusion by 20–25% [19]. Kluge also reported that PVS causes decreased perfusion identified by magnetic resonance perfusion imaging and that this perfusion improved after venoplasty [48]. Changes in the pulmonary blood distribution based on the presence of abnormal V/Q scans were reported by Saad et al. [7].
Diffusion and perfusion MRI of the lung and mediastinum
2010, European Journal of RadiologyCitation Excerpt :In the latter perfusion imaging can also be used for differential diagnosis of different forms of the pulmonary vascular diseases, such as idiopathic pulmonary arterial hypertension (IPAH) or chronic thromboembolic PH (CTEPH). But also the use of pulmonary perfusion imaging for other indications, such as for the diagnosis of pulmonary arteriovenous malformations or the assessment of perfusion changes following radiofrequency ablation of atrial fibrillation have been proposed [47,48]. In patients with suspected PE, Ohno et al. compared the diagnostic accuracy of perfusion MRI using a time-resolved 3D MRA technique with parallel imaging (SENSE) to multi-detector CT (MDCT) and ventilation-perfusion scintigraphy (VQ scan) [49].
Pulmonary MR Angiography Techniques and Applications
2009, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :With the implementation of parallel-imaging techniques, less than 1.5-second 3D acquisitions have become achievable in the clinical setting21,22 and, furthermore, parallel imaging may be combined with view sharing for further reduction in acquisition time or to maintain high temporal resolution of 1.5 seconds but with improved spatial resolution (1.87 × 3.74 × 4 mm3).23,24 There have been many studies exploring gadolinium contrast-enhanced pulmonary perfusion MR for a variety of indications including pulmonary embolism,15,25–27 chronic pulmonary hypertension,28,29 pneumonia,30 lung cancer pre21 and post surgery,31 lung diseases such as chronic obstructive pulmonary disease32 and cystic fibrosis,33 preoperative planning prior resection in cancer, pre- and postoperative assessment of congenital heart disease,34 and post pulmonary venous ablation for atrial fibrillation to assess venous stenoses.35 Gadolinium-based first-pass perfusion may be measured qualitatively, assessing for perfusion defects, semiquantitatively using signal intensity-time curves, or quantitatively using indicator-dilution theory and kinetic modeling.