DIAGNOSIS IN ADOLESCENTS AND ADULTS WITH CONGENITAL HEART-DISEASE - PROSPECTIVE ASSESSMENT OF INDIVIDUAL AND COMBINED ROLES OF MAGNETIC-RESONANCE-IMAGING AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Background The inability to obtain complete diagnoses with transthorac ic echocardiography in many adults with congenital heart disease provi ded the incentive to evaluate prospectively the individual and combine d roles of magnetic resonance imaging (MRI) and transesophageal echoca rdiography (TEE) as ''second-line'' techniques for unresolved diagnost ic problems. Methods and Results Eighty-five patients were studied; 81 had MRI with a 0.5-T magnet to obtain spin-echo images, cine-MRI, and flow-velocity maps. Seventy-nine patients had TEE (37 biplane). A sim ple score (range, 0 to 1) was used for quantification of the results o f MRI and TEE alone, for their comparison (in the 75 patients who had both), and for assessment of their combination. MRI, TEE, or their com bination achieved a score of at least 0.75 in 18 of 25 diagnostic cate gories. A summary of the scores showed that for intracardiac anatomy, MRI scored 0.34, TEE scored 0.71 (P<.0001), and MRI plus TEE scored 0. 84 (P<.003); for extracardiac anatomy, MRI scored 0.76, TEE scored 0.2 3 (P<.0001), and MRI plus TEE scored 0.84 (P=NS); and for hemodynamics and function, MRI scored 0.58, TEE scored 0.41 (P<.05), and MRI plus TEE scored 0.67 (P=NS). Total scores were MRI, 0.52; TEE, 0.50 (P=NS); and MRI plus TEE, 0.80 (P<.0001). MRI and TEE were inadequate for col lateral and coronary arteries and pulmonary vascular resistance. Cine- MRI and flow-velocity maps comprised 43% of the MRI scores. Biplane TE E was better than single plane (scores of 0.59 versus 0.42, P<.0001). Conclusions MRI and TEE are important and complementary ''second-line' ' investigations for congenital heart disease. Analysis of their perfo rmance in a wide range of diagnostic categories provides guidelines fo r their judicious application. Where both are available, diagnostic ca theterizations are either obviated or simplified.