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IRM et Scanner cardiaques: Indications en pédiatrie
Francesca Raimondi Hôpital Necker-Enfant Malades, Paris
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Indications partagées
• Anatomie Intracardiaque: – Etude pre et post-operatoire – Tumeurs, thrombus, péricarde
Extracardiaque - Gros vaisseaux – Shunts et montages chirurgicaux – Artères coronaires proximales
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Scanner vs IRM
• Scanner ü Irradiant ü Examen court ü Haute disponibilité
• IRM ü Non irradiant ü Examen long ü Disponibilité limitée
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Indications Scanner
Anatomie
• Analyse des artères coronaires
• Détails anatomiques dans les pathologies de gros vaisseaux et rapport avec les bronches
• Etude des collatérales aorto-pulmonaires
• Etude du parenchyme pulmonaire
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Indications Scanner
Analyse des artères coronaires
ü Confirmer une anomalie coronaire vue à l’echo (ALCAPA, ARCAPA..)
ü Contrôle post opératoire (anomalie coronaire, TGV)
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Scanner coronaire à Necker
2 37
3
12
42
29
14
611
7 51 2 1 0 2 0 1
0
10
20
30
40
50
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18Age (years)
Num
ber
of P
atie
nts
(Tot
148
)
27 8536
Created with novaPDF Printer (www.novaPDF.com). Please register to remove this message.
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Scanner coronaire à Necker
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Scanner coronaire à Necker
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Scanner coronaire à Necker
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Scanner – Gating prospectif
0,952 mSv
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0,952 mSv
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CDx CDx
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CDx CDx
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Cx
Cx
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Cx
Cx
Cx
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Diagonale
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IVA
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Marginale
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CD+Cx
TC
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7.7 mSv
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0.5 mSv
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0.5 mSV
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IRM - 3D avec double gating
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Indications Scanner
Anatomie
• Détails anatomiques dans les pathologies des gros vaisseaux et rapport avec les bronches
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Indications Scanner
Anatomie
• Etude des collatérales aorto-pulmonaires dans l’APSO
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Anatomie extracardiaque Anatomie complexe
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Anatomie complexe
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Anatomie intracardiaque
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Anatomie complexe Anatomie complexe
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RVPA
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Indications Scanner
Anatomie
• Etude du parenchyme pulmonaire
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Indications IRM
• Morphologie, fonction et analyse tissulaire – Morphologie, Volumes, Masses, Fonction des
ventricules
– Fonction des Valves cardiaques
– Perfusion myocardique/réserve coronaire/réserve contractile
– Perfusion pulmonaire – Etude du myocarde: inflammation/fibrose
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Morphologie et fonction
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Anatomie
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Anatomie
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Stenose supraortique
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Anatomie
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Anatomie
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Anatomie
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Anatomie
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Anatomie
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Volumes-Fonction
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VD systémique / Mustard
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VD systémique / Mustard
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Rastelli
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Chenaux atriaux / Mustard
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Chenaux atriaux / Mustard
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Chenaux atriaux / Senning
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Valves
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Valves: Velocimetrie
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Fontan
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Velocimetrie
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Perfusion myocardique
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Réserve coronaire
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Réserve coronaire
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Réserve coronaire
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Réserve coronaire
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Perfusion pulmonaire
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Perfusion pulmonaire
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• Oedeme • Graisse • Fibrose • Composition tissulaire (spetroscopie)
Analyse tissulaire
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Analyse tissulaire
• Pathologies inflammatoire: myocardite aigue, péricardite
• Myocardiopathies: hypertrophique, dilatative, dysplasie arytmogène du ventricule droit
• Recherche de fibrose ventriculaire dans les cardiopathies congenitales (VD systemique, Tetralogie de Fallot, ALCAPA etc)
• Pathologies avec altération de la composition tissulaire (pathologies métaboliques, glycogénose, amyloïdes, Fabry disease)
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• Edema
• T2-weighted image sensitivity detects tissue edema with the long
• T2 of water bound protons as the contrast-generating mechanism, resulting in a high signal intensity of edematous tissue.
• Hyperemia and capillary leak (myocardial early gadolinium enhancement)
• Contrast-enhanced fast spin-echo T1-weighted MR is used to assess myocardial hyperemia and inflammation.
• Necrosis and fibrosis (late gadolinium enhancement [LGE]) • Myocardial LGE reflects irreversible myocardial injury (i.e.,
necrosis and fibrosis
• Schultz JS, et al. Mayo Clin Proc. 2009
Analyse tissulaire
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Acute myocarditis Cardiovascular Magnetic Resonance
• Primary tool for non invasive assessment of myocardial inflammation
• Diagnostic CMR targets: 1. Functional abnormalities 2. Pericardial effusion 3. Morphological abnormalities 4. Tissue characterization
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Myocardite aigue
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CMR in Acute myocarditis
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Myocardite aigue
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CMR in Acute myocarditis
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T2
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Myocardite aigue
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Fibrose VD systémique
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Cardiomyopathie hypertrophique
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Morphologie
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Echo-IRM
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Phenotype
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Fibrose
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IVS 41 mm
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Tissue analysis
T2 sang noir LGE
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Fibrose
LGE LGE
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Progression: 2012
LW 6.7 mm
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IVS 12 mm, LW 10.5 mm
Progression: 2013
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Progression: 2012
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Tumeurs
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Fibrome
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Fibrome
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Fibrome
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Fibrome
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Fibrome
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Fibrome
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Fibrome
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Fibrome
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Rabdomyome
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Rabdomyome
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Rabdomyome
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Tumeurs
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Role de l’IRM dans les CC
Eur Heart J. Apr 2010
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Mercipourvotrea-en/on…
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Analyse tissulaire complexe
SPECTROMETRIE
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