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a) SCMR official document standardized acquisition guidelines – relevant extract
b) SCMR official document reporting recommendations – relevant extract
Qualitative elements that should be included in CMR-based PV reporting include:
1. Number of pulmonary veins;
2. Atrial side of pulmonary vein return;
3. Recognition of accessory or anomalous pulmonary veins; and
4. Presence or absence of stenosis in each PV, especially in reporting post-ablation CMR exams.
Quantitative elements that should be included in CMR-based PV reporting are:
1. Maximum ostial diameter of each pulmonary vein;
2. Cardiac phase (e.g. end-atrial diastole) and respiratory phase (e.g. end-expiration) during acquisition of images used for ostial measurements;
3. Minimum ostial diameter of each stenotic pulmonary vein; and
4. Imaging technique used for measurements
The number and position of pulmonary veins is accounted for noting common trunks, accessory veins, and evidence for stenosis or thrombosis cross sectional area of the pulmonary vein may be provided. A 3D workstation may be used to calculate major and minor axes, and cross sectional area of each pulmonary vein ostium, and compare pre- and post-ablation images side by side.
SCMR recognizes the value of pictorial display of the pulmonary vein orientations, and suggests implementation of diagrams when feasible
c) Standardized web based images
Case from the Heart Hopsital, London. Indication: Prior to redo atrial ablation. It used 0.1mmol/Kg gadolium at 3mls/s antecubital fossa, parallel imaging. Departing from protocol, no LV function was assessed on this scan. Reconstructions are shown for interest - in practice, these are un-necessary as they are made in Carto/Navex. The right middle pulmonary vein is close to having a separate origin from the right upper and lower PVs.
d) Case of the Week example(s)
Number 08-19 Diagnosing RV dilatation by CMR
History: ** Case of the year winner, 2008
e) Expert opinion – ‘How we do’
f) Relevant Online Talks
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h) Relevant papers (starting point):
Ferrari VA, Scott CH, Holland GA, Axel L, St. John Sutton M: Ultrafast three-dimensional contrast-enhanced MRA and imaging in the diagnosis of partial anomalous pulmonary venous drainage. JACC 2001;37:1120-8.
Greil GF, Powell AJ, Gildein HP et al. Gadolinium-enhanced threedimensional magnetic resonance angiography of pulmonary and systemic venous anomalies. J Am Coll Cardiol 2002;39:335–41.
Valsangiacomo ER, Levasseur S, McCrindle BW et al. Contrastenhanced MR angiography of pulmonary venous abnormalities in children. Pediatr Radiol 2003;33:92–8.
Kato R, Lickfett L, Meininger G, Dickfeld T, Wu R, Juang G et al. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation: lessons learned by use of magnetic resonance imaging. Circulation 2003;107:2004-2010.
Prasad SK, Soukias N, Hornung T, Khan M, Pennell DJ, Gatzoulis MA, Mohiaddin RM. Role of MRA in the Diagnosis of Major Aortopulmonary Collateral Arteries and Partial Anomalous Pulmonary Venous Drainage.Circulation. 2004;109:207-214
Mansour M, Refaat M, Heist EK, Mela T, Cury R, Holmvang G et al. Three-dimensional anatomy of the left atrium by magnetic resonance angiography: implications for catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2006;17:719-723.
Bertaglia E, Brandolino G, Zoppo F, Zerbo F, Pascotto P. Integration of three-dimensional left atrial magnetic resonance images into a real-time electroanatomic mapping system: validation of a registration method. PACE 2008;31:273-282.