Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany.
Eur Heart J Cardiovasc Imaging. 2014 Jan;15(1):6-17. doi: 10.1093/ehjci/jet124. Epub 2013 Aug 2.
Major advances in noninvasive imaging of adult congenital heart disease have been accomplished. These tools play now a key role in comprehensive diagnostic work-up, decision for intervention, evaluation for the suitability of specific therapeutic options, monitoring of interventions and regular follow-up. Besides echocardiography, magnetic resonance (CMR) and computed tomography (CT) have gained particular importance. The choice of imaging modality has thus become a critical issue. This review summarizes strengths and limitations of the different imaging modalities and how they may be used in a complementary fashion. Echocardiography obviously remains the workhorse of imaging routinely used in all patients. However, in complex disease and after surgery echocardiography alone frequently remains insufficient. CMR is particularly useful in this setting and allows reproducible and accurate quantification of ventricular function and comprehensive assessment of cardiac anatomy, aorta, pulmonary arteries and venous return including complex flow measurements. CT is preferred when CMR is contraindicated, when superior spatial resolution is required or when "metallic" artefacts limit CMR imaging. In conclusion, the use of currently available imaging modalities in adult congenital heart disease needs to be complementary. Echocardiography remains the basis tool, CMR and CT should be added considering specific open questions and the ability to answer them, availability and economic issues.
成人先天性心脏病的无创影像学已经取得了重大进展。这些工具现在在综合诊断、干预决策、特定治疗方案适用性评估、干预监测和定期随访中发挥着关键作用。除了超声心动图，磁共振成像（CMR）和计算机断层扫描（CT）也变得尤为重要。因此，选择影像学方式已成为一个关键问题。这篇综述总结了不同影像学方式的优缺点，以及它们如何互补使用。超声心动图显然仍然是所有患者常规使用的成像手段。然而，在复杂疾病和手术后，单独使用超声心动图往往不够。在这种情况下，CMR 特别有用，可以对心室功能进行可重复且准确的量化，并对心脏解剖结构、主动脉、肺动脉和静脉回流进行全面评估，包括复杂的血流测量。当 CMR 不适用、需要更高的空间分辨率或“金属”伪影限制 CMR 成像时，首选 CT。总之，在成人先天性心脏病中，目前可用的影像学方式的使用需要互补。超声心动图仍然是基础工具，应根据具体问题和回答问题的能力、可用性和经济因素添加 CMR 和 CT。
