Juvenile and adult congenital heart disease: Time-resolved 3D contrast-enhanced MR angiography

Purpose: To assess the incremental diagnostic value of time-resolved three-dimensional (3D) magnetic resonance (MR) angiography over single-phase 3D MR angiography and cine MR imaging in juvenile and adult patients with congenital heart disease (CHD). Materials and Methods: The study was HIPAA compliant and was approved by the institutional review board. Written informed consent was obtained from each patient. Eighty-one consecutive patients (46 male and 35 female patients; mean age, 31.1 years ± 13.5 [standard deviation]) with CHD were examined with a 1.5-T MR imaging unit. The imaging protocol comprised time-resolved MR angiography (repetition time msec/echo time msec, 2.01/0.81) after injection of 0.03 mmol gadodiamide per kilogram of body weight at 4 mL/sec and single-phase high-spatial-resolution MR angiography (2.87/0.97) after injection of 0.15 mmol/kg gadodiamide at 1.5 mL/sec. After review of the time-resolved and conventional MR angiographic data sets, each of two independent observers listed the additional clinical information gained from time-resolved MR angiographic data. A Wilcoxon signed rank test was used to test for statistical differences between the image quality ratings of the two observers. Results: Time-resolved and single-phase high-spatial-resolution MR angiography yielded diagnostic image data in all patients. Observers 1 and 2 found functional information in time-resolved MR angiographic series in 52 and 51 patients, respectively, that was not seen at high-spatial-resolution MR angiography. Intra- and extracardiac shunts, respectively, were exclusively depicted by time-resolved MR angiography for observer 1 in 18 and two patients and for observer 2 in 15 and two patients. However, both observers reported higher confidence in the assessment of such smaller vascular structures as supraaortic vessels (in 12 patients for observer 1 and 11 patients for observer 2) and major aortopulmonary collateral arteries (in eight patients for observer 1 and 10 patients for observer 2) at high-spatial-resolution MR angiography. No significant difference was evident in image quality scoring between the two observers (P = .32 for time-resolved and P = .47 for conventional MR angiography). Conclusion: Compared with conventional MR angiography, time-resolved MR angiography yields clinically relevant information in a substantial number of patients; hence, the two techniques should be regarded as complementary.