Volume 126, Issue 2, Pages 428-437 (August 2004) Decreased Pulmonary Perfusion in Pulmonary Vein Stenosis After Radiofrequency Ablation  Alexander Kluge, MD, Thorsten Dill, MD, Okan Ekinci, MD, Jochen Hansel, MD, Christian Hamm, MD, Heinz F. Pitschner, MD, Georg Bachmann, MD  CHEST  Volume 126, Issue 2, Pages 428-437 (August 2004) DOI: 10.1378/chest.126.2.428 Copyright © 2004 The American College of Chest Physicians Terms and Conditions

Figure 1 Scheme for the study on pulmonary perfusion in patients with PVS. CHEST 2004 126, 428-437DOI: (10.1378/chest.126.2.428) Copyright © 2004 The American College of Chest Physicians Terms and Conditions

Figure 2 MR perfusion and corresponding SPECT perfusion images in a 56-year-old woman with severe stenosis of the left upper PV. Ten of 20 transverse slices from the pulmonary apex to the base are shown. Perfusion defects are matched precisely in the MR and the SPECT perfusion images, and only the lingula segment (red circle) of the left upper lobe still retains some perfusion. CHEST 2004 126, 428-437DOI: (10.1378/chest.126.2.428) Copyright © 2004 The American College of Chest Physicians Terms and Conditions

Figure 3 Left: MR pulmonary perfusion and PV diameters measured using MRA in 205 PVs from 51 patients. Numbers indicate the absolute count of PVs with pathologic perfusion compared to the total of PVs with the specified diameter, and bars indicate the percentage of pathologic pulmonary perfusion (the remaining data to 100% are considered to be normal). Perfusion defects prevailed in areas drained by PVs of ≤ 6 mm diameter. Right: MR pulmonary perfusion and MRA PV diameter in corresponding areas after PV dilatation (22 examinations and 88 PVs). The number of PVs with the specified diameter is provided, and bars indicate the percentage of areas with pathologic pulmonary perfusion. In contrast to findings before dilatation (left), normal perfusion was found only in 58.8% of PVs dilatated to ≥ 6 mm. CHEST 2004 126, 428-437DOI: (10.1378/chest.126.2.428) Copyright © 2004 The American College of Chest Physicians Terms and Conditions

Figure 4 Perfusion in a 62-year-old woman before PV dilatation (top left, a, middle left, c, and bottom left, e) and after PV dilatation (top right, b, middle right, d, and bottom right, f). The MRA in the coronal view depicts a severe stenosis of the left upper PV (top left, a; arrowhead). MPR of MRA after dilatation shows the reopened left upper PV (top right, b; arrowhead). Perfusion MRI before dilatation shows a marked decrease in pulmonary perfusion within the left lung (middle left, c). Perfusion MRI after dilatation shows improvement of pulmonary perfusion (middle right, d). Bottom left, e: SPECT before dilatation (corresponding to the same level as in middle left, c). Bottom right, f: SPECT after dilatation shows marked improvement in pulmonary perfusion. CHEST 2004 126, 428-437DOI: (10.1378/chest.126.2.428) Copyright © 2004 The American College of Chest Physicians Terms and Conditions

Figure 5 Pulmonary perfusion after PV dilatation. Values from 12 patients who underwent 12 examinations before dilatation and 22 examinations after dilatation indicate the ratio of relative enhancement in pathologic areas compared to the relative enhancement in corresponding normal areas of the contralateral lung. As such, 1 stands for equilibrate perfusion, and normal was defined as a left/right ratio of between 0.95 and 1.05. Two patients had to be dilatated twice (arrows), one of whom showed further deterioration of pulmonary perfusion. CHEST 2004 126, 428-437DOI: (10.1378/chest.126.2.428) Copyright © 2004 The American College of Chest Physicians Terms and Conditions