Dynamic Time-Resolved Contrast-Enhanced Two-Dimensional MR Projection Angiography of the Pulmonary Circulation: Standard Technique and Clinical Applications
S. Sonnet1,
C. H. Buitrago-Téllez1,
K. Scheffler2,
R. Strecker2,
G. Bongartz1 and
J. Bremerich1
1 Department of Radiology, University Hospital Basel, Petersgraben 4, 4051
Basel, Switzerland.
2 Section of Medical Physics, Department of Radiology, University of Freiburg,
Hugstetterstr. 55, 79106 Freiburg, Germany.
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Fig. 1A. —52-year-old man with exertional dyspnea. Normal anatomy of
pulmonary arterial tree, heart, and great vessels is shown in time-resolved
images. Enhanced subtracted two-dimensional (2D) MR projection image obtained
during early phase displays bolus arrival at right atrium.
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Fig. 1B. —52-year-old man with exertional dyspnea. Normal anatomy of
pulmonary arterial tree, heart, and great vessels is shown in time-resolved
images. Enhanced subtracted 2D MR projection image depicts early pulmonary
arterial phase.
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Fig. 1C. —52-year-old man with exertional dyspnea. Normal anatomy of
pulmonary arterial tree, heart, and great vessels is shown in time-resolved
images. Enhanced subtracted 2D MR projection image shows parenchymal phase
with blush of dye.
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Fig. 1D. —52-year-old man with exertional dyspnea. Normal anatomy of
pulmonary arterial tree, heart, and great vessels is shown in time-resolved
images. Enhanced subtracted 2D MR projection image shows late venous
phase.
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Fig. 2A. —41-year-old woman with pulmonary vasculitis (microscopic
polyangiitis). Enhanced subtracted two-dimensional (2D) MR projection image
shows good delineation of pulmonary trunk and central pulmonary vessels
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Fig. 2B. —41-year-old woman with pulmonary vasculitis (microscopic
polyangiitis). Enhanced subtracted 2D MR projection image reveals narrowing of
peripheral small vessels during pulmonary arterial phase; narrowing
(arrows) is more predominant on left side.
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Fig. 2C. —41-year-old woman with pulmonary vasculitis (microscopic
polyangiitis). Enhanced subtracted 2D MR projection image shows area of
peripheral narrowing of small vessels adjacent to minor fissure
(arrowheads, right middle field), which is also well demarcated.
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Fig. 2D. —41-year-old woman with pulmonary vasculitis (microscopic
polyangiitis). Enhanced subtracted 2D MR projection image shows delayed
parenchymal perfusion with bolus passage through aorta that underlines
previously described pulmonary findings.
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Fig. 2E. —41-year-old woman with pulmonary vasculitis (microscopic
polyangiitis). In this enhanced subtracted 2D MR projection image, region of
interest and magnification for F are marked with white rectangle.
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Fig. 2F. —41-year-old woman with pulmonary vasculitis (microscopic
polyangiitis). Magnified enhanced subtracted 2D MR projection image (marked in
E) shows that changes in small vessels at periphery of upper left lobe
(arrows) are more severe than changes in vessels in right lobe.
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Fig. 3A. —17-year-old boy with partial anomalous pulmonary venous
return. Enhanced subtracted two-dimensional (2D) MR projection image shows
early filling of pulmonary trunk.
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Fig. 3B. —17-year-old boy with partial anomalous pulmonary venous
return. Enhanced subtracted 2D MR projection image displays delineation of
normal pulmonary arterial vessels.
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Fig. 3C. —17-year-old boy with partial anomalous pulmonary venous
return. Enhanced subtracted 2D MR projection image clearly shows anomalous
vertical vein of left upper lobe (arrowheads) draining into high
portion of superior vena cava (arrows).
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Fig. 3D. —17-year-old boy with partial anomalous pulmonary venous
return. Enhanced subtracted 2D MR projection image obtained during late venous
phase shows anomalous vertical vein (arrowheads) and superior vena
cava (arrows).
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Fig. 4A. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Two-dimensional MR projection angiogram shows early bolus
passage through right heart and pulmonary trunk. Note signal loss in upper
lobe region resulting from bronchial artery embolization 1 year earlier.
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Fig. 4B. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Two-dimensional MR projection angiogram in pulmonary
arterial phase displays one peripheral nodular lesion (short arrow)
with early venous drainage. Note larger nodular lesion (long arrow)
at right hilus.
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Fig. 4C. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Two-dimensional MR projection angiogram depicts early
venous vessel (arrows) arising from peripheral nodule with anomalous
pulmonary venous drainage in superior vena cava. Nodular hilar lesion on right
side is also well delineated.
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Fig. 4D. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Two-dimensional MR projection angiogram obtained at later
stage displays feeding arterial vessel (arrows) and draining venous
vessel (arrowheads) of peripheral pulmonary malformation.
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Fig. 4E. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Three-dimensional contrast-enhanced MR angiogram confirms
hemodynamic findings detected on time-resolved MR angiography. Feeding
arterial vessel (arrow) and draining venous vessel
(arrowhead) of peripheral pulmonary malformation are simultaneously
shown in this three-dimensional data acquisition.
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Fig. 4F. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Conventional digital subtraction angiogram depicts early
pulmonary phase.
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Fig. 4G. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Conventional digital subtraction angiogram obtained during
parenchymal phase shows peripheral nodular lesion (arrows).
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Fig. 4H. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Conventional digital subtraction angiogram reveals early
draining venous vessel (arrowheads) with anomalous return in superior
vena cava as previously depicted on MR projection angiogram.
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Fig. 4I. —12-year-old girl with complex arteriovenous malformation.
Comparison of pulmonary time-resolved two-dimensional MR projection angiograms
(A—D), three-dimensional contrast-enhanced MR angiograms
(E), and conventional angiograms using digital subtraction technique
(F—I). Conventional digital subtraction angiogram also confirms
central nodular lesion (arrow) in right hilus.
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Copyright © 2002 by the American Roentgen Ray Society.
