Difficult exams in children

CMR in children is not so straightforward. This paper provides some hints on how to get better images when doing perfusion studies.

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Research
Feasibility of perfusion cardiovascular magnetic resonance in paediatric patients

Emanuela R Valsangiacomo Buechel1 email, Christian Balmer1 email, Urs Bauersfeld1 email, Christian J Kellenberger2 email and Juerg Schwitter3 email

1University Children's Hospital Zurich, Division of Paediatric Cardiology, 8032 Zurich, Switzerland

2University Children's Hospital Zurich, Division of Diagnostic Imaging, 8032 Zurich, Switzerland

3University Hospital Zurich, Clinic of Cardiology, Zurich, Switzerland

author email corresponding author email

Journal of Cardiovascular Magnetic Resonance 2009, 11:51doi:10.1186/1532-429X-11-51
Published: 30 November 2009
Abstract
Aims

As coronary artery disease may also occur during childhood in some specific conditions, we sought to assess the feasibility and accuracy of perfusion cardiovascular magnetic resonance (CMR) in paediatric patients.
Methods and results

First-pass perfusion CMR studies were performed under pharmacological stress with adenosine and by using a hybrid echo-planar pulse sequence with slice-selective saturation recovery preparation. Fifty-six perfusion CMR examinations were performed in 47 patients. The median age was 12 years (1 month-18 years), and weight 42.8 kg (2.6-82 kg). General anaesthesia was required in 18 patients. Mean examination time was 67 ± 19 min. Diagnostic image quality was obtained in 54/56 examinations. In 23 cases the acquisition parameters were adapted to patient's size. Perfusion CMR was abnormal in 16 examinations. The perfusion defects affected the territory of the left anterior descending coronary artery in 11, of the right coronary artery in 3, and of the circumflex coronary artery in 2 cases. Compared to coronary angiography, perfusion CMR showed a sensitivity of 87% (CI 52-97%) and a specificity of 95% (CI 79-99%).
Conclusion

In children, perfusion CMR is feasible and accurate. In very young children (less than 1 year old), diagnostic image quality may be limited.