Tetralogy of Fallot Radiology

8/9/2019 Tetralogy of Fallot Radiology

1/13

JOURNAL READING

IMAGING IN TETRALOGY OF FALLOT

Diajukan Untuk Memenuhi Syarat Stase Radi!"i

ERLAN ANUGRA# $RATAMA

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FA*ULTAS *EDO*TERAN

UNI+ERSITAS $EM,ANGUNAN NASIONAL

-+ETERAN. JA*ARTA

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2/13

IMAGING IN TETRALOGY OF FALLOT

Author: S Bruce Greenberg, MD; Chie E!itor : Eugine C Lin, MD

O"er"ie#

Tetr$%og& o F$%%ot i' the (o't co((on t&)e o c&$notic congenit$% he$rt!i'e$'e* It con'i't' o $ right "entricu%$r out%o# tr$ct ob'truction, $($%$%ign(ent "entricu%$r 'e)t$% !eect, $n o"erri!ing $ort$, $n! right"entricu%$r h&)ertro)h&, $' !e(on'tr$te! in the i($ge be%o#*

M$gnetic re'on$nce i($ge o the he$rt in $n in$nt #ithtetr$%og& o F$%%ot* Thi' i($ge 'ho#' $ %$rge "entricu%$r 'e)t$% !eect $n! right "entricu%$r h&)ertro)h&* Note the!e'cen!ing $ort$ i' on the right, con'i'tent #ith $ right+'i!e! $ortic $rch*

$re0erred e1aminatinEchoc$r!iogr$)hic in!ing' $re !i$gno'tic or tetr$%og&o F$%%ot in in$nt' $n! &oung chi%!ren, $n!echoc$r!iogr$)h& ($& be the on%& e$(in$tion

re-uire! beore 'urger&* Con"ention$% r$!iogr$)h&, ($gnetic re'on$ncei($ging .MRI/, $n! $ngiogr$)h& $re $%'o he%)u% or co()%ete )reo)er$ti"ee"$%u$tion* Angiogr$)h& h$' been u'e! or )reo)er$ti"e e"$%u$tion o thecoron$r& $rterie' $n! )eri)her$% )u%(on$r& circu%$tion; ho#e"er, intr$c$r!i$cc$theteri0$tion ($& 'ti(u%$te )u%(on$r& out%o# tr$ct ')$'(* Nonin"$'i"e)eri)her$% )u%(on$r& $rteri$% e"$%u$tion i' )o''ib%e #ith MRI*

In the )o'to)er$ti"e e"$%u$tion, echoc$r!iogr$)h& $n! MRI $re )reerre!* Thechoice o i($ging e$(in$tion' !e)en!' on their $"$i%$bi%it& $n! c%inic$%)reerence*

Limitatins 0 te2hni3ues

Echoc$r!iogr$)hic in!ing' $re !i$gno'tic o intr$c$r!i$c $bnor($%itie', butechoc$r!iogr$)h& i' %i(ite! in the e"$%u$tion o the )eri)her$% )u%(on$r&$rterie' $n! co%%$ter$% %o#* I the con%uence or )re'ence o the br$nch)u%(on$r& $rterie' i' in !oubt $ter echoc$r!iogr$)h&, )eror( MRI or $ngiogr$)h&*

Re2ent studies

In $ 'tu!&, Fr$t0 et $% conc%u!e! th$t $ter correction o tetr$%og& o F$%%ot,#hen "entricu%$r "o%u(e' $re (e$'ure! #ith c$r!i$c MRI, $i$% '%ice' oer gre$ter re)ro!ucibi%it& th$n !o 'hort+$i' '%ice'* The& oun! th$t "o%u(e'!eter(ine! u'ing $i$% '%ice' #ere 'ub1ect to 'igniic$nt%& %e'' intr$ob'er"er "$ri$tion or right $n! %et "entricu%$r en!+!i$'to%ic "o%u(e' $n! or %et"entricu%$r en!+'&'to%ic "o%u(e'* The '$(e #$' true or interob'er"er "$ri$tion or right $n! %et "entricu%$r en!+'&'to%ic "o%u(e' $n! or %et"entricu%$r en!+!i$'to%ic "o%u(e'*

http://emedicine.medscape.com/article/903271-overviewhttp://emedicine.medscape.com/article/2035949-overviewhttp://emedicine.medscape.com/article/2035949-overviewhttp://emedicine.medscape.com/article/903271-overview


3/13

Iri$rt et $% co()$re! intr$ob'er"er $n! interob'er"er "$ri$tion' #hen 2+

!i(en'ion$% .2D/ tr$n'thor$cic echoc$r!iogr$)h& .co(bine! #ith $'e(i$uto($tic bor!er !etection $%gorith(/ #$' u'e! to (e$'ure right"entricu%$r "o%u(e' $n! e1ection r$ction' in )$tient' #ith correcte! tetr$%og&o F$%%ot* The in"e'tig$tor' oun! $ir $gree(ent bet#een 2Dechoc$r!iogr$)h& $n! MRI in the $''e''(ent o right "entricu%$r "o%u(e' $n!e1ection r$ction'; the& $%'o conc%u!e! th$t intr$ob'er"er $n! interob'er"er "$ri$bi%it& or 2D echoc$r!iogr$)h& #$' $!e-u$te* The& note!, ho#e"er, th$t2D echoc$r!iogr$)h& !i')%$&e! re!uce! $ccur$c& in the (e$'ure(ent o %$rger right "entricu%$r "o%u(e'*

3ohi et $% u'e! c$r!i$c ($gnetic re'on$nce )$r$(eter' to $''e'' right

"entricu%$r unction in )$tient' #ith co(bine! )u%(on$r& 'teno'i' $n!)u%(on$r& in'uicienc& $n! )$tient' #ith i'o%$te! )u%(on$r& in'uicienc&o%%o#ing tetr$%og& o F$%%ot re)$ir* The& conc%u!e! th$t right "entricu%$r unction i' better )re'er"e! in )$tient' #ith )u%(on$r& 'teno'i' $n!in'uicienc&*456

S$!egh)our et $% oun! $ 'igniic$nt corre%$tion bet#een Do))%er+!eri"e!(e$n 'tr$in o right "entricu%$r ree #$%% $n! the right "entricu%$r unction(e$'ure! b& c$r!i$c ($gnetic re'on$nce in $!u%t' $ter tetr$%og& o F$%%otre)$ir *476

In $n $''e''(ent o right "entricu%$r unction $ter 'urger& or tetr$%og& o F$%%ot, 3oc$ et $% conc%u!e! th$t (&oc$r!i$% )eror($nce in!e $n!i'o"o%u(ic $cce%er$tion in!ing' obt$ine! ro( Do))%er i($gingechoc$r!iogr$)h& c$n be u'e! or %ong+ter( o%%o# u), but the& !o notcorre%$te #ith c$r!i$c ($gnetic re'on$nce+origin$te! right "entric%e e1ectionr$ction $n! )u%(on$r& regurgit$tion r$ction*

$atient Edu2atin4 For ece%%ent )$tient e!uc$tion re'ource', "i'iteMe!icine8e$%th9' 8e$rt 8e$%th Center * A%'o, 'ee eMe!icine8e$%th9' )$tiente!uc$tion $rtic%e Tetr$%og& o F$%%ot*

RadiographyOn r$!iogr$)h', the c$r!i$c 'i%houette in )$tient' #ith tetr$%og& o F$%%ot i'nor($% in 'i0e; ho#e"er, right "entricu%$r h&)ertro)h& c$n e%e"$te the %et"entric%e* Co(bine! #ith $ '($%% or $b'ent ($in )u%(on$r& $rter& 'eg(ent,the he$rt c$n h$"e the c%$''ic boot+'h$)e! $))e$r$nce .$' 'een in the i($gebe%o#/* Mo't chi%!ren #ith tetr$%og& o F$%%ot !o not h$"e boot+'h$)e! he$rt*

R$!iogr$)h o $ boot+'h$)e! he$rt in $n in$nt #ithtetr$%og& o F$%%ot*T&)ic$%%&, the $))e$r$nce o the "$'cu%$rit& o the)u%(on$r& $rter& i' re!uce!, but it c$n $%'o be

nor($%* Decre$'e! )u%(on$r& "$'cu%$rit& i're-uent%& !iicu%t or the gener$% r$!io%ogi't to

http://emedicine.medscape.com/article/899249-overviewhttp://emedicine.medscape.com/article/899249-overviewhttp://www.emedicinehealth.com/collections/CO1572.asphttp://www.emedicinehealth.com/Articles/11205-1.asphttp://emedicine.medscape.com/article/899249-overviewhttp://emedicine.medscape.com/article/899249-overviewhttp://www.emedicinehealth.com/collections/CO1572.asphttp://www.emedicinehealth.com/Articles/11205-1.asp


4/13

$))reci$te* L$rge co%%$ter$%' ($& gi"e the $))e$r$nce o nor($% "$'cu%$rit&*

The en%$rge! $ort$ in chi%!ren #ith $ right+'i!e! $rch c$n c$u'e $ir#$&

co()re''ion th$t c$n be i!entiie! on che't r$!iogr$)h', $' !e(on'tr$te! inthe i($ge' be%o#* A right+'i!e! $rch i' )re'ent in 7 o chi%!ren #ithtetr$%og& o F$%%ot, $n! it c$n be i!entiie! b& (e$n' o !irect "i'u$%i0$tion,#ith !i')%$ce(ent o the tr$che$ to the %et or #ith incre$'e! o)$cit& o the')in$% )e!ic%e' on the i)'i%$ter$% 'i!e o the $ortic $rch* The )o'ition o the$ortic $rch in%uence' 'urgic$% )%$nning bec$u'e B%$%oc


5/13

!i'e$'e th$n truncu' $rterio'u'*

Computed TomographyCo()ute! to(ogr$)h& .CT/ 'c$nning h$' $n inre-uent ro%e in the e"$%u$tiono tetr$%og& o F$%%ot* Thi' (o!$%it& i' u'eu% or the e"$%u$tion o 'urgic$%co()%ic$tion' 'uch $' inection or )'eu!o$neur&'( or($tion* 8e%ic$% CT'c$nning c$n be u'e! to i!enti& $ir#$& co()re''ion th$t i' c$u'e! b& $ %$rge$'cen!ing $ort$ th$t i' $''oci$te! #ith tetr$%og& o F$%%ot*

Magnetic Resonance Imaging

S)in+echo MRI c$n be u'e! to i!enti& the (or)ho%ogic $bnor($%itie' o tetr$%og& o F$%%ot, #hich $re $' o%%o#': right "entricu%$r out%o# tr$ct

ob'truction, "entricu%$r 'e)t$% !eect, right "entricu%$r h&)ertro)h&, $n! $no"erri!ing $ort$* .E$()%e' o the'e e$ture' $re 'een in the i($ge be%o#*/

M$gnetic re'on$nce i($ge o the he$rt in $nin$nt #ith tetr$%og& o F$%%ot* Thi' i($ge 'ho#' $%$rge "entricu%$r 'e)t$% !eect $n! right "entricu%$r h&)ertro)h&* Note the !e'cen!ing $ort$ i' on theright, con'i'tent #ith $ right+'i!e! $ortic $rch*The con%uence, )re'ence, $n! 'i0e o the br$nch)u%(on$r& $rterie' c$n be i!entiie! .'ee thei($ge be%o#/* MRI (e$'ure(ent' o the 'i0e o

the )u%(on$r& $n! br$nch )u%(on$r& $rterie' $re$' $ccur$te $' $ngiogr$)hic (e$'ure(ent', $n!the& c$n be u'e! to c$%cu%$te the McGoon r$tio$n! the N$


6/13

Ob%i-ue i($ging #ith thin 'ection' ($& be nece''$r& to "eri& )u%(on$r&$rteri$% con%uence $n! i!enti& h&)o)%$'tic )u%(on$r& $rterie' in neon$te'$n! in$nt'* F%o# $n$%&'i' o )u%(on$r& regurgit$tion i' 'u'ce)tib%e to $%i$'ingi the "e%ocit& enco!ing i' too %o#*

UltrasonographyEchoc$r!iogr$)h& i' the )ri($r& i($ging (etho! or e$(ining $ chi%! in#ho( tetr$%og& o F$%%ot i' 'u')ecte!* Intr$c$r!i$c $no($%ie', inc%u!ing)u%(on$r& inun!ibu%$r $n! "$%"u%$r 'teno'i' $n! the )o'ition o the $ortic rooto"erri!ing the "entricu%$r 'e)t$% !eect, $re i!entiie! #ith +!i(en'ion$%echoc$r!iogr$)h&* The origin' o the coron$r& $rterie' c$n $%'o be i!entiie!*

Do))%er u%tr$'onogr$)hic e$(in$tion o the )u%(on$r& out%o# tr$ct c$n beu'e! to (e$'ure the "e%ocit& gr$!ient in the right "entricu%$r out%o# tr$ct $n!to !ierenti$te 'e"ere 'teno'i' ro( $tre'i$* Continuit& o the br$nch)u%(on$r& $rter& #ith the ($in )u%(on$r& $rter& c$n be i!entiie!, $n! the'i0e o the br$nch )u%(on$r& $rterie' c$n be (e$'ure!* The initi$% )%$ce(ento )$%%i$ti"e 'hunt' i' %i


7/13

C$theter 'tu!ie' re($in the criterion 't$n!$r! or b%oo! )re''ure(e$'ure(ent' $n! (or)ho%ogic i($ging o the coron$r& $n! br$nch)u%(on$r& $rterie'* Nonin"$'i"e techni-ue' $re )reerre! #hen the& $re$"$i%$b%e 'o th$t "$'cu%$r $cce'' or )otenti$% uture inter"ention$% )roce!ure'i' )re'er"e!*

Fa!se 5siti6es7ne"ati6es

>n%i


8/13

Tetr$%ogi o F$%%ot $!$%$h 1eni' &$ng )$%ing u(u( !$ri )en&$


9/13

b$g$i($n$)un, b$h#$ 2D echoc$r!iogr$)h& !it$()i%


10/13

)$!$ 'i'i


11/13

Ma"neti2 Resnan2e Ima"in"S)in+echo MRI !$)$t !igun$


12/13

!ee< 'e)tu( "entri


13/13

Fa!se 5siti0 7 ne"ati0Ti!$< 'e)erti 'tu!i inheren to(ogr$i 'e)erti echoc$r!iogr$)h&, MRI, !$n CT'c$n, $ngiogr$i (ung

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Tetralogy of Fallot Radiology