Final Pr. ID: Poster #: SCI-034
Cardiac magnetic resonance imaging (CMR) is commonly used in evaluation of patients with repaired Tetralogy of Fallot (TOF). Impaired peak strain by echocardiography in TOF has been associated with adverse clinical outcome. Assessment of myocardial deformation (strain) using novel CMR software may provide prognostic information in TOF. Because of ventricular interaction, abnormal left ventricle (LV) mechanics are seen in echocardiography speckle tracking. We aimed to determine correlates of right (RV) and LV function using LV diastolic filling analysis in patients with repaired TOF. Read More
Final Pr. ID: Poster #: EDU-090
The structure of the heart is more complex than 4 major chambers, 4 major valves, venous inflow and arterial outflow.
Muscular and soft tissue ridges, perforated membranes, tissue flaps, electrical pathways, external grooves, endocardial surface characteristics, and a core architecture structured of fibrous tissue and embryonic tissue remnants form distinguishing anatomic landmarks. These structures provide insight into cardiac development, serve physiologic purpose, define structural and functional elements, as well as offer prognostic information.
Specific details of cardiac anatomy may not be recognized on cardiac MR and CT examinations. Structural anomalies that affect cardiac function and anatomic or physiologic relationships may be abnormal in hearts with congenital malformations. The fine structural details of the heart are typically not part of an imagers search pattern and are therefore overlooked or underreported. Each minute structure and anatomic characteristic provides clues to errors in cardiac formation and may provide clinically relevant diagnostic information. After palliation of CHD defining anatomic structure may be lost, displaced, interrupted or even restored.
Important processes, corresponding anatomic landmarks, and effects of malformation in defining congenital heart disease anatomy, physiology and functional variation from normal include basal structures such as the central fibrous body of the heart, atrial structures including the crista terminalis, the sinus venarum, and eustacian valve, and ventricular structures such as the crista supraventricularis.
Each structure is described along with its normal location, anatomy functional and physiologic importance, the effect of congenital malformation, and imaging findings as in the example of the central fibrous body (table 1).
Minute cardiac anatomy will be shown in illustration as well as in CT and MR images (figure 1). Read More
Final Pr. ID: Poster #: SCI-019
Fetal demise (FD) occurs in 1/1000 pregnancies after 20 weeks gestation. MRI is increasingly being used after ultrasound to assess fetal pathology. FD may occur in the interval between ultrasound and MRI, and various organ systems have been described as having changes on fetal MRI. Although ultrasound findings of FD have been well described, criteria for FD on MRI have not. Diffusion MRI evaluates Na+/K+ channel viability and can be used to evaluate tissue death. Flowing blood produces signal loss on MRI, and along with fetal heart activity results in MRI signal loss of the cardiac chambers. FD with no heart motion and increased signal within non-flowing blood in the heart should result in increased signal in the chambers relative to the myocardium. Either of these findings can be seen with different fetal pathology, but the combination of brain and cardiac changes may allow for a diagnosis of FD. We hypothesize that restricted brain diffusion in certain brain lobes along with increased signal within heart chambers is specific for FD. Read More
Final Pr. ID: Poster #: EDU-005
Over the last twenty years there has been a rapid expansion in the vast array of implantable cardiac devices utilized in pediatric patients. Imaging plays a key role in the management of patients with these devices. It is important for the pediatric radiologist to recognize the specific type of cardiac device visualized on radiographic images in order to make an accurate assessment of the appropriate position and any potential complications. With new cardiac devices entering the market it can be very perplexing and daunting for the radiologist to stay familiar with them all.
We will seek to review old and new pediatric cardiac devices currently used at our institution and their radiographic appearance.
These devices will be divided into categories of pacing devices, prosthetic heart valves, stents, closure devices, ventricular assist devices, extracorporeal membrane oxygenation systems (ECMO), and external monitoring devices.
Pacing devices: a) Epicardial and transvenous pacing systems b) Leadless pacemakers
Prosthetic heart valves: a) Surgically implanted valves b) Transcatheter valves
Closure devices: a) Patent ductus arteriosus closure device, b) Atrial septal defect closure device c) Vascular plugs and coils
Ventricular assist devices: a) Left ventricular assist device, b) Right ventricular assist device, c) Bi-ventricular assist device
Extracorporeal membrane oxygenation (ECMO) cannulas: a) Venous-arterial ECMO, b) Venous-venous ECMO
External monitoring devices: a) Holter monitor, b) Loop recorder Read More
Final Pr. ID: Poster #: EDU-003
Magnetic resonance imaging (MRI) has historically been restricted for patients with pacemakers, defibrillators, or other cardiac implantable electronic devices (CIEDs) due to safety concerns. Despite the introduction of MR conditional pacemakers in 2008, access to MRI in patients with CIEDS remains limited.
MRI remains the diagnostic imaging study of choice for many indications and is necessary to prevent delayed diagnosis and the decision to proceed with MRI should follow a rigorous risk benefit assessment:
Lead heating causing injury at their tips
Increased pacing thresholds
Sudden battery depletion
The location of the image should be considered because if the request includes the area of the CIED then potential artifacts may decrease the diagnostic quality. However, an MRI remote from the location of the CIED entails a negligible risk of lead heating and MRI may be performed safely with continuous patient monitoring throughout the scan. In addition, in pediatric patients the necessity of anesthesia or sedation must be well-thought-out as it conveys additional risk to the patient.
There is growing evidence from adult literature that MRI may be performed safely in patients with CIEDs with transvenous leads when appropriate protocols are followed. The Heart Rhythm Society (HRS) 2017 expert consensus statement indicates that MRI is reasonable in patients with MR non-conditional transvenous CIEDs if there are no fractured, epicardial, or abandoned leads. The Pediatric and Congenital Electrophysiology Society (PACES) of 2021 included that MRI may be considered in pediatric patients with epicardial or abandoned leads on a case-by-case basis. However, performing MRI in patients with CIEDs is a resource-intensive service and requires rigorous implant investigation, preparation, and planning as well as close coordination between treating physicians and radiologist.
This educational exhibit summarizes current literature on the safety of MRI in patients with CIEDs and takes examples from our practice to build an evaluation program that allows for safe access to MRI in patients with CIEDs Read More
Keywords: Cardiac, Magnetic Resonance
Final Pr. ID: Paper #: 016
To characterize the range of cardiac and extracardiac CT findings in children with thoracic ectopia cordis in the setting of Cantrell syndrome.
Final Pr. ID: Paper #: 100
Purpose is to describe how FCMR is instrumental in diagnosis of congenital heart disease (CHD) and to present imaging findings and correlation in 50 fetuses with CHD. Read More
Final Pr. ID: Poster #: EDU-006
The purpose of this educational exhibit is to show FCMR images of congenital heart disease (CHD) and anatomical findings associated with CHD. We will describe currently available FCMR image acquisition techniques and use a case-based approach to show a variety of CHD diagnosis with teaching points to highlight the added value of FCMR in diagnosis and prognosis. Read More
Final Pr. ID: Paper #: 107
The purpose of this study is to report visualization rates for standard cardiac axial views by FCMR using a prospective ECG pseudogating method and compare visualization rates for acquisitions performed in 1.5 and 3T. Secondary aims include a comparison of image quality between 2 observers and between 1.5 and 3T. Specific absorption rates (SAR) are also compared. Read More
Final Pr. ID: Poster #: EDU-010
1. Review the safety, limitations and advantages of fetal cardiac MR (CMR)
2. Discuss potentialindications of fetal CMR
3. Describe the technique of fetal CMR, including imaging sequences, imaging planes, the method
of overcoming motion artifact
4. Illustrate the appearance of normal fetal cardiac structures and present a modified anatomic
segmental approach of congenital heart disease (CHD) at prenatal CMR
5. Demonstrate examples of fetal CMR in the evaluation of various cardiovascular anomalies Read More
Authors: Dong Su-zhen
Final Pr. ID: Paper #: 014
To assess the image quality and clinical performance of a novel accelerated, free-breathing 2D cine cardiac MR sequence with DCNN reconstruction in comparison to conventional breath-held 2D cine balanced steady-state free precession (bSSFP). Read More
Final Pr. ID: Poster #: EDU-003
The purpose of this educational presentation is to review the feed and wrap method, also known as feed and sleep, swaddle, or bundle, as an alternative to deep sedation or general anesthesia through a pictorial review of cardiac magnetic resonance (MR) studies performed using this method. The feed and wrap technique in which feeding and warmth are used to induce sleep and swaddling is used to reduce motion is described. Indications and contraindications as well risks and benefits of this method versus general anesthesia and deep sedation are discussed. Multiple examples of congenital heart disease including atrial and ventricular septal defects, atrioventricular canal defects, and double outlet right ventricle are provided, with sequences used, length of scan, and diagnostic quality also summarized. The example shown in Figures 1-3 is a 12-day-old female. The scan was completed in 12 minutes without intravenous contrast. Figure 1 is the scout image showing situs inversus. Figure 2 is a gated axial steady state free procession (SSFP) image showing a membranous ventricular septal defect (yellow arrow), an atrial septal defect (yellow arrowhead), and atrial inversion. Figure 3 is a 4D flow reconstruction showing the superior and inferior vena cava entering anatomic right atrium on the left, a right aortic arch with mirror branch pattern, and relationship to the main pulmonary artery (MPA). Read More
Final Pr. ID: Poster #: EDU-004
CHD (congenital heart disease) occurs in approximately 1% of all live births with more than 90% survival into adulthood. Prevalence of coronary artery disease has been reported to be similar to general adult population. Patients with complex CHD may be subjected to non-atherosclerotic premature coronary artery disease due to anomalous coronaries, peri-coronary region interventions, or coronary re-implantation. Cardiac MRI (CMR) may provide valuable myocardium health information with pointers towards a coronary distribution in unsuspected chronic or acute cases. Acquisition of delayed enhancement sequences (LGE) and T1 mapping should be considered routine in CMR studies for assessment of interval ischemic events. Patients with complex CHD are also at risk for sudden cardiac arrest and LGE data may assist in further risk stratification of these patients. Three complex CHD patients who all suffered myocardial infarctions at a young age as a result of their multifaceted cardiac history are highlighted to illustrate the importance of this (see included table, Figure 1). Two CMR images (Figures 2,3) demonstrate delayed enhancement throughout the septum at the base to mid-cavity in a patient with truncus arteriosus type 1 who presented with a non-ST-elevation myocardial infarction (NSTEMI). Focal area of low-signal sub-endocaridum within the enhancement on Figure 3 favors microvascular obstruction.
CMR is a vital component of surgical planning and post-operative care of patients with CHD, providing accurate anatomical, functional, and flow information that assists in clinical management. Delayed enhancement sequences and post-gadolinium T1 mapping allow assessment of ischemic injury or infarct, and therefore should be considered part of routine follow up CMR studies in patients with complex CHD. Read More
Final Pr. ID: Poster #: SCI-001
As more pediatric patients are infected with severe acute respiratory syndrome coronavirus 2 during the coronavirus disease 2019 (COVID-19) pandemic, more have been diagnosed with multisystemic inflammatory syndrome in children (MIS-C). Early research investigations into MIS-C show cardiac involvement presenting as elevated troponins, ventricular dysfunction, electrical conduction abnormalities, and pericardial effusions. MIS-C may result in myocardial perfusion defects visualized with nuclear medicine imaging and magnetic resonance imaging (MRI), however these perfusion defects on contrast enhanced computed tomography (CT) have not yet been described. Read More
Keywords: Cardiac, COVID
Final Pr. ID: Poster #: EDU-002 (T)
Purpose: The long-term effects from gadolinium tissue deposition in organs and the brain is unknown especially in children who may need repeated contrast studies for necessary follow-up of cardiovascular abnormalities. We aim to show the utility of a non-contrast MRA sequence in older children and young adults undergoing chest and/or abdominal MRA. Read More
Final Pr. ID: Poster #: EDU-093
Cardiomyopathy is rare in children but associated with significant morbidity and mortality when symptomatic. It also comprises a large proportion of cardiac MR imaging referrals in typical pediatric radiology practice. The purpose of this educational exhibit is to review the major types of cardiomyopathy in children, focusing on cardiac MRI. Read More
Authors: Zucker Evan
Final Pr. ID: Poster #: EDU-004
Congenital heart diseases often occurs secondary to a variety of insults and rotational errors during development in utero. These can range from a spectrum of simple to more complex pathologies including arterial switches. It is important for radiologists to recognize the embryology and complications of arterial switches to further management. Today largely secondary to new advances in technology both corrected and uncorrected arterial switches are diagnosed more commonly; previously many patients with arterial switches may not have survived into adulthood.
In utero, the primitive truncus is normally positioned anterior and midline. It eventually divides into the aorta and the pulmonary artery, which then rotates clockwise 150 degrees such that the pulmonary artery lies anterior to and left of the aorta. When variations occur it can result in a congenitally corrected transposition such as L- transposition of the great arteries (L-TGA) where the two ventricles are morphologically switched in position. With L-TGA, the truncus rotates 30-degrees clockwise which results in the aorta being anterior and leftward in relation to the pulmonary artery.
In uncorrected transposition (R-TGA) the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, secondary to a 30-degree counterclockwise rotation of the primitive truncus, the aorta is then located rightward and anterior to the pulmonary artery. This condition needs to be corrected surgically due to cyanosis resulting from the right ventricle not being able to supply the systemic circulation. Other variations of arterial switches that can occur is situs inversus where the rotation of the aorta and pulmonary artery is completely opposite of that which would be considered normal. Lastly in truncus arteriosus, the primitive truncus does not divide into a separate aorta and pulmonary artery. We will provide several cases from our institution of arterial switches on imaging as well as diagramatic representative models describing the embryology of how arterial switches and rotations occur. We also discuss the repairs and complications of these cases. Read More
Keywords: cardiac, Pulmonary
Final Pr. ID: Poster #: EDU-009
To provide a working knowledge of normal cardiac anatomy and a systematic guide to findings in common and uncommon congenital heart disease as seen on cardiac CTA. Read More
Authors: Scace Candace
Final Pr. ID: Poster #: SCI-019
Right ventricular (RV) function represents a prognostic marker in patients with congenital heart defects (CHD), essentially in patients with right bundle branch block (RBBB). Due to the limitations of echocardiographic ventricle volume assessment, cardiac magnetic resonance imaging (CMR) is nowadays the method of choice in the follow-up of these patients.
In a recently published study it has been shown that delayed RV contraction due to RBBB should be taken into account when performing CMR volumetric assessment with short axis plane method.
Since recent recommendations suggest axial plane volume measurements, therefore current work was designed to assess the impact of RBBB on cardiac volumetric parameters evaluated with the axial plane method. Read More
Final Pr. ID: Poster #: EDU-005
The purpose of this educational presentation is to provide a pictorial review to promote recognition and understanding of the embryology, anatomy and spectrum of interruption of the aortic arch (IAA) in children. Read More
Final Pr. ID: Poster #: SCI-003
The advent of fast CT scanners with lower radiation doses has resulted in rapid growth in the numbers of cardiac CTs being performed in children. This has also increased the number of CTs interpreted by cardiologists, similar to adult cardiac CT. Pediatric cardiac CT demonstrates multiple potential extracardiac variants and pathology that may occur in conjunction with congenital heart disease (CHD). Prior publications in adult cohorts demonstrate a wide-range and incidence of extracardiac findings (6-39%) but the prevalence in children is unknown. Therefore, the purpose of this abstract is to describe incidence, distribution and significance of the extracardiac findings found in pediatric cardiac CT at a tertiary referral center. Read More
Keywords: cardiac, extracardiac
Final Pr. ID: Poster #: EDU-002
Truncus arteriosus is a rare congenital cardiac anomaly characterized by failure of conoseptal separation resulting in a single arterial trunk supplying both the pulmonary and systemic circulation. Diagnosis has historically been made with fetal echocardiography, and palliative surgery performed frequently in the neonatal period. Cross-sectional imaging is typically reserved for post-operative complications. However, due to lower dose radiation and faster scanners, preoperative CT angiography imaging is becoming more common with the increasing use of cardiac EKG-gated CT angiograms, requiring pediatric imagers to be familiar with the diagnosis of the truncus arteriosus spectrum.
Final Pr. ID: Paper #: 041
Introduction: Conventional pediatric MRI acquisitions of a short axis (SA) stack for ventricular volumes typically requires one breath-hold per slice, resulting in multiple coordinated breath-holds under anesthesia to acquire the entire stack. Here, we aim to validate a compressed sensing approach to reduce breath-holding during SA balanced steady state free precession (bSSFP) cine imaging. Equivalency is tested via qualitative image scoring and global volumes compared to conventional bSSFP cine imaging. Read More