MR Imaging and CT of Vascular Anomalies and Connections

MR Imaging and CT of Vascular Anomalies and Connections


Linda B. Haramati, MD ; Julie S. Glickstein, MD ; Henry J. Issenberg, MD ; Nogah Haramati, MD ; Gregory A. Crooke, MD

1 From the Departments of Radiology (L.B.H., N.H.), Pediatric Cardiology (H.J.I.), and Cardiothoracic Surgery (G.A.C.), Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; and the Division of Pediatric Cardiology, New York Presbyterian Hospital, Children’s Hospital of New York, and Columbia University, New York, NY (J.S.G.). Recipient of an Excellence in Design award for an education exhibit at the 2000 RSNA scientific assembly. Received May 24, 2001; revision requested July 5 and received July 26; accepted July 30.

To plan effective management of congenital heart disease, one needs the clearest understanding of the anatomy. Although echocardiography and angiography are the dominant imaging modalities in patients with congenital heart disease, magnetic resonance (MR) imaging and computed tomography (CT) are valuable noninvasive adjuncts. MR imaging and CT are effective in demonstrating the complex cardiovascular morphology present in congenital heart disease, especially the extracardiac morphology. In patients with tetralogy of Fallot with complex pulmonary artery anatomy, MR imaging and CT are useful in demonstrating the pulmonary artery anatomy, along with the significant aortopulmonary collateral vessels. In the heterotaxy syndromes, patients often have unusual atriovenous connections. MR imaging allows accurate identification of the hepatic, systemic, and pulmonary veins and their relationships to both atria. CT and MR are the imaging modalities of choice in a patient who is thought to have a vascular ring. Treatment of aortic coarctation is usually performed on the basis of typical clinical and echocardiographic findings. In patients with atypical clinical or echocardiographic findings, MR imaging and CT yield helpful information that can change the treatment plan. The enhanced preoperative understanding of congenital heart disease provided by MR imaging and CT simplifies surgical decision making and consequently may improve outcome.