Calidad de la coronariografía 3D por resonancia magnética en los pacientes con D-transposición de las grandes arterias intervenidos con switch arterial de Jatene / Quality of 3D magnetic resonance imaging of coronary arteries in patients with D-transposition of the great arteries after the Jatene switch procedure

Objetivos. Valorar la calidad de imagen de la secuencia 3D de todo el corazón (3D balanced fast field echo, whole heart [WH3D]) para estudiar la anastomosis coronaria y las estenosis coronarias en los pacientes con D-transposición de las grandes arterias intervenidos con switch arterial de Jatene. Material y métodos. Rescatamos de la base de datos de RM cardiaca pediátrica 100 exploraciones en 83 pacientes intervenidos con la técnica de Jatene y secuencia WH3D. Cumplían criterios de inclusión en el estudio 84 exploraciones. Valoramos las estenosis coronarias mediante WH3D y su correlación con la TC coronaria o la angiografía por catéter. Estudiamos retrospectivamente la calidad de la imagen de las arterias coronarias proximales con una escala de 4 puntos y la correlación con la edad, frecuencia cardiaca y tamaño cardiaco. Resultados. Cuatro de los 84 estudios (4,8%) mostraron calidad «insuficiente» para el diagnóstico, 7 (8,3%) «discreta», 23 (27,4%) «buena» y 50 (59,5%) «excelente». La frecuencia cardiaca y la calidad de la imagen coronaria se relacionaron estadísticamente. Con la RM detectamos estenosis en el origen coronario en 9 exploraciones (10,7%). Conclusión. La calidad de imagen con la secuencia WH3D fue diagnóstica en la mayoría de los pacientes intervenidos con la técnica de Jatene, mejor en pacientes con menor frecuencia cardiaca. En el 10,7% se diagnosticó una estenosis del origen coronario que obligó a nuevas exploraciones (AU)

Objectives. To evaluate the quality of images obtained with 3D balanced fast-field echo whole heart (WH3D) MRI sequences for assessing the coronary anastomosis and coronary stenosis in patients with D-transposition of the great arteries who have undergone the Jatene switch procedure. Material and methods. We retrieved 100 WH3D studies done in 83 patients who had undergone the Jatene switch procedure from our pediatric cardiac MRI database; 84 of these studies fulfilled the criteria for inclusion in the study. We evaluated coronary stenoses on WH3D MR images and their correlation with coronary CT or angiography images. We retrospectively studied the quality of the images of the proximal coronary arteries using a four-point scale and correlating the findings with age, heart rate, and heart size. Results. Of the 84 studies, 4 (4.8%) were of a quality considered «insufficient for diagnosis», 7 (8.3%) were considered «fair», 23 (27.4%) «good», and 50 (59.5%) «excellent». The quality of the image of the coronary arteries was significantly correlated with heart rate. MRI detected stenosis in the origin of the coronary arteries in 9 (10.7%) studies. Conclusion. Images obtained with the WH3D MRI sequence in patients who had undergone the Jatene procedure were of diagnostic quality in most cases and were better in patients with lower heart rates. In 10.7%, stenosis in the origin of the coronary arteries that required new studies was detected (AU)

[Quality of 3D magnetic resonance imaging of coronary arteries in patients with D-transposition of the great arteries after the Jatene switch procedure]. / Calidad de la coronariografía 3D por resonancia magnética en los pacientes con D-transposición de las grandes arterias intervenidos con switch arterial de Jatene.

OBJECTIVES: To evaluate the quality of images obtained with 3D balanced fast-field echo whole heart (WH3D) MRI sequences for assessing the coronary anastomosis and coronary stenosis in patients with D-transposition of the great arteries who have undergone the Jatene switch procedure. MATERIAL AND METHODS: We retrieved 100 WH3D studies done in 83 patients who had undergone the Jatene switch procedure from our pediatric cardiac MRI database; 84 of these studies fulfilled the criteria for inclusion in the study. We evaluated coronary stenoses on WH3D MR images and their correlation with coronary CT or angiography images. We retrospectively studied the quality of the images of the proximal coronary arteries using a four-point scale and correlating the findings with age, heart rate, and heart size. RESULTS: Of the 84 studies, 4 (4.8%) were of a quality considered «insufficient for diagnosis¼, 7 (8.3%) were considered «fair¼, 23 (27.4%) «good¼, and 50 (59.5%) «excellent¼. The quality of the image of the coronary arteries was significantly correlated with heart rate. MRI detected stenosis in the origin of the coronary arteries in 9 (10.7%) studies. CONCLUSION: Images obtained with the WH3D MRI sequence in patients who had undergone the Jatene procedure were of diagnostic quality in most cases and were better in patients with lower heart rates. In 10.7%, stenosis in the origin of the coronary arteries that required new studies was detected.

[Gadolinium-based contrast agents for magnetic resonance imaging]. / Contrastes basados en gadolinio utilizados en resonancia magnética.

Gadolinium-based contrast agents are increasingly being used in magnetic resonance imaging. These agents can improve the contrast in images and provide information about function and metabolism, increasing both sensitivity and specificity. We describe the gadolinium-based contrast agents that have been approved for clinical use, detailing their main characteristics based on their chemical structure, stability, and safety. In general terms, these compounds are safe. Nevertheless, adverse reactions, the possibility of nephrotoxicity from these compounds, and the possibility of developing nephrogenic systemic fibrosis will be covered in this article. Lastly, the article will discuss the current guidelines, recommendations, and contraindications for their clinical use, including the management of pregnant and breast-feeding patients.

Contrastes basados en gadolinio utilizados en resonancia magnética / Gadolinium-based contrast agents for magnetic resonance imaging

Los medios de contraste basados en gadolinio son cada vez más utilizados en estudios de resonancia magnética. Son capaces de mejorar el contraste en las imágenes y aportar información sobre la función y el metabolismo, aumentando la sensibilidad así como la especificidad diagnóstica. Se describen los diferentes medios de contraste basados en gadolinio aprobados para uso clínico actualmente, sus características principales en base a su estructura química, estabilidad y seguridad. En términos generales son compuestos seguros. No obstante, las reacciones adversas producidas, la posible nefrotoxicidad inducida por estos compuestos, así como la posibilidad de desarrollar fibrosis sistémica nefrogénica serán temas tratados en la presente publicación. Por último, se mencionarán las actuales guías, recomendaciones y contraindicaciones en cuanto a su utilización en el ámbito clínico, incluyendo el manejo en pacientes gestantes y en la lactancia (AU)

Gadolinium-based contrast agents are increasingly being used in magnetic resonance imaging. These agents can improve the contrast in images and provide information about function and metabolism, increasing both sensitivity and specificity. We describe the gadolinium-based contrast agents that have been approved for clinical use, detailing their main characteristics based on their chemical structure, stability, and safety. In general terms, these compounds are safe. Nevertheless, adverse reactions, the possibility of nephrotoxicity from these compounds, and the possibility of developing nephrogenic systemic fibrosis will be covered in this article. Lastly, the article will discuss the current guidelines, recommendations, and contraindications for their clinical use, including the management of pregnant and breast-feeding patients (AU)