MRI Evaluation of Lymphatic Abnormalities in the Neck and Thorax after Fontan Surgery: Relationship with Outcome
Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior cavopulmonary connection (SCPC); lymphatic abnormalities after SCPC may be demonstrated at MRI and prior to the Fontan operation. Purpose To determine...
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| Vydané v: | Radiology Ročník 291; číslo 3; s. 774 |
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| Hlavní autori: | , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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United States
01.06.2019
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| ISSN: | 1527-1315, 1527-1315 |
| On-line prístup: | Zistit podrobnosti o prístupe |
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| Abstract | Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior cavopulmonary connection (SCPC); lymphatic abnormalities after SCPC may be demonstrated at MRI and prior to the Fontan operation. Purpose To determine if the degree of neck and thoracic lymphatic abnormalities at T2-weighted MRI in patients after superior cavopulmonary connection (SCPC) correlated with surgical outcomes from the Fontan procedure. Materials and Methods Patients for whom SCPC was performed for palliation of single ventricle disease who underwent chest MRI between July 2012 and May 2015 at a single institution were retrospectively reviewed. T2-weighted images were scored as lymphatic type 1 (little or no T2 mediastinal and supraclavicular signal) to type 4 (T2 signal into both the mediastinum and the lung parenchyma). Fontan takedown, duration of post-Fontan hospitalization and pleural effusion, postoperative plastic bronchitis, need for transplant, and mortality were tabulated. The relationship between lymphatic type and clinical outcomes was evaluated by using analysis of variance (ANOVA), the Kruskal-Wallis H test, and the Fisher exact test. Results A total of 83 patients (mean age, 7.9 years ± 2.6) were evaluated. Among these 83 patients, 53 (64%) were classified with type 1 or 2 lymphatic abnormalities, 17 (20%) with type 3, and 12 (16%) with type 4. The rate of failure of Fontan completion was higher in patients with type 4 than in type 1 or 2 (54% vs 2%, respectively;
= .004). Need for cardiac transplant (one of 13 [8%]) and death (three of 13 [23%]) occurred only in type 4. Median postoperative length of stay was longer for patients with type 4 than for those with types 1 or 2 (29 days vs 9 days, respectively;
< .01). Conclusion Greater MRI-based severity of lymphatic abnormalities in patients prior to planned Fontan procedure was associated with failure of Fontan completion and longer postoperative stay. © RSNA, 2019 |
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| AbstractList | Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior cavopulmonary connection (SCPC); lymphatic abnormalities after SCPC may be demonstrated at MRI and prior to the Fontan operation. Purpose To determine if the degree of neck and thoracic lymphatic abnormalities at T2-weighted MRI in patients after superior cavopulmonary connection (SCPC) correlated with surgical outcomes from the Fontan procedure. Materials and Methods Patients for whom SCPC was performed for palliation of single ventricle disease who underwent chest MRI between July 2012 and May 2015 at a single institution were retrospectively reviewed. T2-weighted images were scored as lymphatic type 1 (little or no T2 mediastinal and supraclavicular signal) to type 4 (T2 signal into both the mediastinum and the lung parenchyma). Fontan takedown, duration of post-Fontan hospitalization and pleural effusion, postoperative plastic bronchitis, need for transplant, and mortality were tabulated. The relationship between lymphatic type and clinical outcomes was evaluated by using analysis of variance (ANOVA), the Kruskal-Wallis H test, and the Fisher exact test. Results A total of 83 patients (mean age, 7.9 years ± 2.6) were evaluated. Among these 83 patients, 53 (64%) were classified with type 1 or 2 lymphatic abnormalities, 17 (20%) with type 3, and 12 (16%) with type 4. The rate of failure of Fontan completion was higher in patients with type 4 than in type 1 or 2 (54% vs 2%, respectively;
= .004). Need for cardiac transplant (one of 13 [8%]) and death (three of 13 [23%]) occurred only in type 4. Median postoperative length of stay was longer for patients with type 4 than for those with types 1 or 2 (29 days vs 9 days, respectively;
< .01). Conclusion Greater MRI-based severity of lymphatic abnormalities in patients prior to planned Fontan procedure was associated with failure of Fontan completion and longer postoperative stay. © RSNA, 2019 Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior cavopulmonary connection (SCPC); lymphatic abnormalities after SCPC may be demonstrated at MRI and prior to the Fontan operation. Purpose To determine if the degree of neck and thoracic lymphatic abnormalities at T2-weighted MRI in patients after superior cavopulmonary connection (SCPC) correlated with surgical outcomes from the Fontan procedure. Materials and Methods Patients for whom SCPC was performed for palliation of single ventricle disease who underwent chest MRI between July 2012 and May 2015 at a single institution were retrospectively reviewed. T2-weighted images were scored as lymphatic type 1 (little or no T2 mediastinal and supraclavicular signal) to type 4 (T2 signal into both the mediastinum and the lung parenchyma). Fontan takedown, duration of post-Fontan hospitalization and pleural effusion, postoperative plastic bronchitis, need for transplant, and mortality were tabulated. The relationship between lymphatic type and clinical outcomes was evaluated by using analysis of variance (ANOVA), the Kruskal-Wallis H test, and the Fisher exact test. Results A total of 83 patients (mean age, 7.9 years ± 2.6) were evaluated. Among these 83 patients, 53 (64%) were classified with type 1 or 2 lymphatic abnormalities, 17 (20%) with type 3, and 12 (16%) with type 4. The rate of failure of Fontan completion was higher in patients with type 4 than in type 1 or 2 (54% vs 2%, respectively; P = .004). Need for cardiac transplant (one of 13 [8%]) and death (three of 13 [23%]) occurred only in type 4. Median postoperative length of stay was longer for patients with type 4 than for those with types 1 or 2 (29 days vs 9 days, respectively; P < .01). Conclusion Greater MRI-based severity of lymphatic abnormalities in patients prior to planned Fontan procedure was associated with failure of Fontan completion and longer postoperative stay. © RSNA, 2019 Online supplemental material is available for this article.Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior cavopulmonary connection (SCPC); lymphatic abnormalities after SCPC may be demonstrated at MRI and prior to the Fontan operation. Purpose To determine if the degree of neck and thoracic lymphatic abnormalities at T2-weighted MRI in patients after superior cavopulmonary connection (SCPC) correlated with surgical outcomes from the Fontan procedure. Materials and Methods Patients for whom SCPC was performed for palliation of single ventricle disease who underwent chest MRI between July 2012 and May 2015 at a single institution were retrospectively reviewed. T2-weighted images were scored as lymphatic type 1 (little or no T2 mediastinal and supraclavicular signal) to type 4 (T2 signal into both the mediastinum and the lung parenchyma). Fontan takedown, duration of post-Fontan hospitalization and pleural effusion, postoperative plastic bronchitis, need for transplant, and mortality were tabulated. The relationship between lymphatic type and clinical outcomes was evaluated by using analysis of variance (ANOVA), the Kruskal-Wallis H test, and the Fisher exact test. Results A total of 83 patients (mean age, 7.9 years ± 2.6) were evaluated. Among these 83 patients, 53 (64%) were classified with type 1 or 2 lymphatic abnormalities, 17 (20%) with type 3, and 12 (16%) with type 4. The rate of failure of Fontan completion was higher in patients with type 4 than in type 1 or 2 (54% vs 2%, respectively; P = .004). Need for cardiac transplant (one of 13 [8%]) and death (three of 13 [23%]) occurred only in type 4. Median postoperative length of stay was longer for patients with type 4 than for those with types 1 or 2 (29 days vs 9 days, respectively; P < .01). Conclusion Greater MRI-based severity of lymphatic abnormalities in patients prior to planned Fontan procedure was associated with failure of Fontan completion and longer postoperative stay. © RSNA, 2019 Online supplemental material is available for this article. |
| Author | DeWitt, Aaron G Saul, David Fogel, Mark A Rychik, Jack Gillespie, Matthew J Dori, Yoav Glatz, Andrew C Morrison, Rodney E Whitehead, Kevin K Goldberg, David J Griffis, Heather Harris, Matthew A O'Byrne, Michael L Rome, Jonathan J Biko, David M Pinto, Erin M Johnstone, Jordan A Partington, Sara L |
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and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 4 givenname: Rodney E surname: Morrison fullname: Morrison, Rodney E organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 5 givenname: Jordan A orcidid: 0000-0002-2908-854X surname: Johnstone fullname: Johnstone, Jordan A organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 6 givenname: Heather surname: Griffis fullname: Griffis, Heather organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 7 givenname: Michael L surname: O'Byrne fullname: O'Byrne, Michael L organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 8 givenname: Mark A surname: Fogel fullname: Fogel, Mark A organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 9 givenname: Matthew A surname: Harris fullname: Harris, Matthew A organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 10 givenname: Sara L surname: Partington fullname: Partington, Sara L organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 11 givenname: Kevin K surname: Whitehead fullname: Whitehead, Kevin K organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 12 givenname: David surname: Saul fullname: Saul, David organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 13 givenname: David J surname: Goldberg fullname: Goldberg, David J organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 14 givenname: Jack surname: Rychik fullname: Rychik, Jack organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 15 givenname: Andrew C surname: Glatz fullname: Glatz, Andrew C organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 16 givenname: Matthew J surname: Gillespie fullname: Gillespie, Matthew J organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 17 givenname: Jonathan J surname: Rome fullname: Rome, Jonathan J organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) – sequence: 18 givenname: Yoav surname: Dori fullname: Dori, Yoav organization: From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30938628$$D View this record in MEDLINE/PubMed |
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| Snippet | Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior... |
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| SubjectTerms | Child Child, Preschool Fontan Procedure - adverse effects Fontan Procedure - mortality Fontan Procedure - statistics & numerical data Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Humans Length of Stay Lymphatic Abnormalities - diagnostic imaging Lymphatic Abnormalities - etiology Lymphatic System - diagnostic imaging Lymphatic System - pathology Magnetic Resonance Imaging Neck - diagnostic imaging Neck - pathology Postoperative Complications - diagnostic imaging Postoperative Complications - etiology Retrospective Studies Thorax - diagnostic imaging Thorax - pathology Treatment Outcome |
| Title | MRI Evaluation of Lymphatic Abnormalities in the Neck and Thorax after Fontan Surgery: Relationship with Outcome |
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