Magnetic resonance imaging guided catheterisation for assessment of pulmonary vascular resistance: in vivo validation and clinical application in patients with pulmonary hypertension

T Kuehne, S Yilmaz, I Schulze-Neick, E Wellnhofer, P Ewert, E Nagel, P Lange, T Kuehne, S Yilmaz, I Schulze-Neick, E Wellnhofer, P Ewert, E Nagel, P Lange

Abstract

Objectives: To validate in vivo a magnetic resonance imaging (MRI) method for measurement of pulmonary vascular resistance (PVR) and subsequently to apply this technique to patients with pulmonary hypertension (PHT).

Methods and results: PVR was assessed from velocity encoded cine MRI derived pulmonary artery (PA) flow volumes and simultaneously determined invasive PA pressures. For pressure measurements flow directed catheters were guided under magnetic resonance fluoroscopy at 1.5 T into the PA. In preliminary validation studies (eight swine) PVR was determined with the thermodilution technique and compared with PVR obtained by MRI (0.9 (0.5) v 1.1 (0.3) Wood units.m2, p = 0.7). Bland-Altman test showed agreement between both methods. Inter-examination variability was high for thermodilution (6.2 (2.2)%) but low for MRI measurements (2.1 (0.3)%). After validation, the MRI method was applied in 10 patients with PHT and five controls. In patients with PHT PVR was measured at baseline and during inhalation of nitric oxide. Compared with the control group, PVR was significantly increased in the PHT group (1.2 (0.8) v 13.1 (5.6) Wood units.m2, p < 0.001) but decreased significantly to 10.3 (4.6) Wood units.m2 during inhalation of nitric oxide (p < 0.05). Inter-examination variability of MRI derived PVR measurements was 2.6 (0.6)%. In all experiments (in vivo and clinical) flow directed catheters were guided successfully into the PA under MRI control.

Conclusions: Guidance of flow directed catheters into the PA is feasible under MRI control. PVR can be determined with high measurement precision with the proposed MRI technique, which is a promising tool to assess PVR in the clinical setting.

Figures

Figure 1
Figure 1
Magnetic resonance fluoroscopic images of the heart. Note the balloon tipped catheter (arrows) in the (A) right atrium, (B) right ventricular outflow tract, and (C) main pulmonary artery of a control patient, and (D) in the largely dilated main pulmonary artery of a patient with pulmonary hypertension (PHT). The balloon is inflated with carbon dioxide and produces a localised susceptibility artefact (arrows).
Figure 2
Figure 2
Bland-Altman plots for comparison of magnetic resonance imaging (MRI) and thermodilution (TD) derived pulmonary flow volumes and arterial resistance in vivo.
Figure 3
Figure 3
Representative phasic pulmonary flow as measured with velocity encoded cine MRI. Note differences in flow volumes between patients with primary and secondary forms of PHT.
Figure 4
Figure 4
Effects of nitric oxide (NO) inhalation in eight patients with PHT compared with measurements acquired at baseline. Data are presented as mean (SD); *p

References

    1. Friedman W, Heiferman M. Clinical problems of postoperative pulmonary vascular disease. Am J Cardiol 1982;50:631–6.
    1. Spray T, Mallory G, Canter C, et al. Pediatric lung transplantation for pulmonary hypertension and congenital heart disease. Ann Thorac Surg 1992;54:216–23.
    1. Schulze-Neick I, Hartenstein P, Li J, et al. Intravenous sildenafil is a potent pulmonary vasodilator in children with congenital heart disease. Circulation 2003;108:II167–73.
    1. Espersen K, Jensen E, Rosenborg D, et al. Comparison of cardiac output measurement techniques: thermodilution, Doppler, CO2-rebreathing and the direct Fick method. Acta Anaesthesiol Scand 1995;39:245–51.
    1. Hillis L, Firth B, Winniford M. Variability of right-sided cardiac oxygen saturations in adults with and without left-to-right. Am J Cardiol 1986;58:129–32.
    1. Van Grondelle A, Ditchey RV, Groves BM, et al. Thermodilution method overestimates low cardiac output in humans. Am J Physiol 1983;245:H690–2.
    1. Wippermann C, Huth R, Schmidt F, et al. Continuous measurement of cardiac output by the Fick principle in infants and children: comparison with the thermodilution method. Intensive Care Med 1996;22:467–71.
    1. Borges A, Wensel R, Opitz C, et al. Relationship between haemodynamics and morphology in pulmonary hypertension: a quantitative intravascular ultrasound study. Eur Heart J 1997;18:1988–94.
    1. Ivy D, Neish S, Knudson O, et al. Intravascular ultrasonic characteristics and vasoreactivity of the pulmonary vasculature in children with pulmonary hypertension. Am J Cardiol 1998;81:740–8.
    1. Stevenson JG. Comparison of several noninvasive methods for estimation of pulmonary artery pressure. J Am Soc Echocardiogr 1989;2:157–71.
    1. Kuehne T, Saeed M, Higgins CB, et al. Endovascular stents in pulmonary valve and artery in swine: feasibility study of MR imaging-guided deployment and postinterventional assessment. Radiology 2003;226:475–81.
    1. Schala S, Saeed M, Higgins CB, et al. Magnetic resonance imaging guided cardiac catheterization in swine model of atrial septal defect. Circulation 2003;108:1865–70.
    1. Muthurangu V, Taylor A, Andriantsimiavona R, et al. Novel method of quantifying pulmonary vascular resistance by use of simultaneous invasive pressure monitoring and phase-contrast magnetic resonance flow. Circulation 2004;110:826–34.
    1. Rebergen S, van der Wall E, Doornbos J, et al. Magnetic resonance measurement of velocity and flow: technique, validation, and cardiovascular applications. Am Heart J 1993;126:1439–56.
    1. Stahlberg F, Sondergaard L, Thomsen C, et al. Quantification of complex flow using MR phase imaging--a study of parameters influencing the phase/velocity relation. Magn Reson Imaging 1992;10:13–23.
    1. Fratz S, Hess J, Schwaiger M, et al. More accurate quantification of pulmonary blood flow by magnetic resonance imaging than by lung perfusion scintigraphy in patients with Fontan circulation. Circulation 2002;106:1510–3.
    1. Beerbaum P, Korperich H, Barth P, et al. Noninvasive quantification of left-to-right shunt in pediatric patients: phase-contrast cine magnetic resonance imaging compared with invasive oximetry. Circulation 2001;103:2476–82.
    1. Miquel ME, Hegde S, Muthurangu V, et al. Visualization and tracking of an inflatable balloon catheter using SSFP in a flow phantom and in the heart and great vessels of patients. Magn Reson Med 2004;51:988–95.
    1. Beerbaum P, Korperich H, Gieseke J, et al. Rapid left-to-right shunt quantification in children by phase-contrast magnetic resonance imaging combined with sensitivity encoding (SENSE). Circulation 2003;108:1355–61.
    1. Sitbon O, Brenot F, Denjean A, et al. Inhaled nitric oxide as a screening vasodilator agent in primary pulmonary hypertension: a dose-response study and comparison with prostacyclin. Am J Respir Crit Care Med 1995;151:384–9.
    1. Rickers C, Seethamraju R, Jerosch-Herold M, et al. Magnetic resonance imaging guided cardiovascular interventions in congenital heart diseases. J Interv Cardiol 2003;16:143–7.
    1. Bakker CJ, Bos C, Weinmann HJ. Passive tracking of catheters and guidewires by contrast-enhanced MR fluoroscopy. Magn Reson Med 2001;45:17–23.
    1. Kuehne T, Fahrig R, Butts K. Pair of resonant fiducial markers for localization of endovascular catheters at all catheter orientations. J Magn Reson Imaging 2003;17:620–4.
    1. Rudolph A. Congenital diseases of the heart: clinical-physiological considerations. New York: Futura Publishing Company, 2001.
    1. Stevenson J. Effect of unilateral diaphragm paralysis on branch pulmonary artery flow. J Am Soc Echocardiogr 2002;15:1127–31.
    1. Welch E, Duara S, Suguihara C, et al. Validation of cardiac output measurements with noninvasive Doppler echocardiography by thermodilution and Fick methods in newborn piglets. Biol Neonate 1994;66:137–45.
    1. Laffon E, Laurent F, Bernard V, et al. Noninvasive assessment of pulmonary arterial hypertension by MR phase-mapping method. J Appl Physiol 2001;90:2197–202.
    1. Evans A, Iwai F, Grist T, et al. Magnetic resonance imaging of blood flow with a phase subtraction technique: in vitro and in vivo validation. Invest Radiol 1993;28:109–15.
    1. Thompson R, McVeigh E. Real-time volumetric flow measurements with complex-difference MRI. Magn Reson Med 2003;50:1248–55.

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