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Communications to the Editor |

Comparison of Helical CT Scanning and MRI in the Follow-up of Adults With Coarctation of the Aorta FREE TO VIEW

Alfred Hager, MD; Harald Kaemmerer, MD, VMD; John Hess, MD
Author and Funding Information

Technische Universität München, München, Germany

Correspondence to: Alfred Hager, MD, Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr 36, D-80636 München, Germany; e-mail: hager@dhm.mhn.de



Chest. 2005;127(6):2296. doi:10.1378/chest.127.6.2296
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To the Editor:

Vriend et al1outlined in their letter to the editor that the capabilities of MRI are not only limited to a detailed imaging of the entire aorta but also allow functional flow measurements. Therefore, they favor MRI over helical CT scanning in the follow-up of patients with coarctation of the aorta. We totally agree that new functional measurements performed with MRI can contribute to the diagnostic workup of coarctation patients and that it might be even more cost-effective to perform MRI without echocardiography in the regular follow-up.2 But, at the moment, the availability and experience for MRI in congenital cardiology are very limited to a small number of centers worldwide.

We wanted to point out in our study3 that both helical CT scanning and MRI are highly useful for the imaging of the thoracic aorta in patients with coarctation, but measurements obtained from different methods in sequential studies should be interpreted with care. The following attributes favor helical CT scanning: better resolution; less investigation time; no disturbance with pacemakers; better compatibility with intensive care monitoring; and, generally, greater availability. Other attributes favor MRI, like the possibility of additional functional studies, the lack of ionizing radiation, and, maybe, the lack of need for contrast media. Therefore, the optimal imaging method should be selected for every individual patient. Shifts between methods should be avoided.

From a scientific point of view, there is no doubt that MRI measurement of collateral flow,4the elastic properties of the aorta,5flow profiles at different sites of the arterial vessels, and many other functional questions are compelling issues of coarctation research, as coarctation seems to be not only a local defect, but also a systemic vessel disease with alterations in the vessel wall68 and in the vascular response.9 However, this was not the primary aim of our study.

Vriend JWJ, Oosterhof T, Mulder BJM. Non-invasive imaging for the (post-operative) assessment of aortic coarctation patients. Chest 2005 (in press).
 
Therrien, J, Thorne, SA, Wright, A, et al Repaired coarctation: a “cost-effective” approach to identify complications in adults.J Am Coll Cardiol2000;35,997-1002. [CrossRef] [PubMed]
 
Hager, A, Kaemmerer, H, Leppert, A, et al Follow-up of adults with coarctation of the aorta: comparison of helical CT and MRI, and impact on assessing diameter changes.Chest2004;126,1169-1176. [CrossRef] [PubMed]
 
Steffens, JC, Bourne, MW, Sakuma, H, et al Quantification of collateral blood flow in coarctation of the aorta by velocity encoded cine magnetic resonance imaging.Circulation1994;90,937-943. [CrossRef] [PubMed]
 
Rees, S, Somerville, J, Ward, C, et al Coarctation of the aorta: MR imaging in late postoperative assessment.Radiology1989;173,499-502. [PubMed]
 
Isner, JM, Donaldson, RF, Fulton, D, et al Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites.Circulation1987;75,689-695. [CrossRef] [PubMed]
 
Connolly, HM, Huston, J, 3rd, Brown, RD, Jr, et al Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients.Mayo Clin Proc2003;78,1491-1499. [CrossRef] [PubMed]
 
Smith Maia, MM, Cortes, TM, Parga, JR, et al Evolutional aspects of children and adolescents with surgically corrected aortic coarctation: clinical, echocardiographic, and magnetic resonance image analysis of 113 patients.J Thorac Cardiovasc Surg2004;127,712-720. [CrossRef] [PubMed]
 
Aggoun, Y, Sidi, D, Bonnet, D Arterial dysfunction after treatment of coarctation of the aorta.Arch Mal Coeur Vaiss2001;94,785-789. [PubMed]
 

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References

Vriend JWJ, Oosterhof T, Mulder BJM. Non-invasive imaging for the (post-operative) assessment of aortic coarctation patients. Chest 2005 (in press).
 
Therrien, J, Thorne, SA, Wright, A, et al Repaired coarctation: a “cost-effective” approach to identify complications in adults.J Am Coll Cardiol2000;35,997-1002. [CrossRef] [PubMed]
 
Hager, A, Kaemmerer, H, Leppert, A, et al Follow-up of adults with coarctation of the aorta: comparison of helical CT and MRI, and impact on assessing diameter changes.Chest2004;126,1169-1176. [CrossRef] [PubMed]
 
Steffens, JC, Bourne, MW, Sakuma, H, et al Quantification of collateral blood flow in coarctation of the aorta by velocity encoded cine magnetic resonance imaging.Circulation1994;90,937-943. [CrossRef] [PubMed]
 
Rees, S, Somerville, J, Ward, C, et al Coarctation of the aorta: MR imaging in late postoperative assessment.Radiology1989;173,499-502. [PubMed]
 
Isner, JM, Donaldson, RF, Fulton, D, et al Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites.Circulation1987;75,689-695. [CrossRef] [PubMed]
 
Connolly, HM, Huston, J, 3rd, Brown, RD, Jr, et al Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients.Mayo Clin Proc2003;78,1491-1499. [CrossRef] [PubMed]
 
Smith Maia, MM, Cortes, TM, Parga, JR, et al Evolutional aspects of children and adolescents with surgically corrected aortic coarctation: clinical, echocardiographic, and magnetic resonance image analysis of 113 patients.J Thorac Cardiovasc Surg2004;127,712-720. [CrossRef] [PubMed]
 
Aggoun, Y, Sidi, D, Bonnet, D Arterial dysfunction after treatment of coarctation of the aorta.Arch Mal Coeur Vaiss2001;94,785-789. [PubMed]
 
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