4D flow vs. 2D cardiac MRI for the evaluation of pulmonary regurgitation and ventricular volume in repaired tetralogy of Fallot: a retrospective case control study

Jacobs, Kimberley; Chan, Frandics P.; Cheng, Joseph Y.; Vasanawala, Shreyas S.; Maskatia, Shiraz A.

doi:10.1007/s10554-019-01751-1

Cited by 23 publications

(20 citation statements)

References 46 publications

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“…Similar to our study, Jacobs et al found a good agreement between 4D-CMR and 2D-CMR flows regarding the RF in pulmonary arteries [12]. Also, Raluca et al [13] demonstrated a good correlation between both methods regarding flow volumes.…”

Section: Discussionsupporting

confidence: 90%

Assessment of flow pattern of right ventricle outflow and pulmonary arteries in surgically corrected tetralogy of Fallot patients by four-dimensional cardiac magnetic resonance flow

et al. 2020

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Background The most common post-surgical complication of tetralogy of Fallot (TOF) is pulmonary regurgitation (PR) which can lead to right ventricle (RV) dysfunction/failure. Cardiac magnetic resonance (CMR) is the imaging modality of choice to follow-up a repaired TOF. However, the conventional two-dimensional phase-contrast (2D-PC) flow usually underestimates PR as well as the pulmonary peak systolic velocity (PSV). Recently, four-dimensional (4D) CMR flow is introduced for more accurate quantitative flow assessment. This work aimed to compare between 4D-CMR and 2D-PC flow across the main (MPA), right (RPA), and left (LPA) pulmonary arteries (PAs) in surgically corrected TOF patients. Results This study was conducted on 20 repaired TOF patients (range 3–9 years, 50% males). All patients had CMR exam on 1.5T scanner. 4D-CMR and 2D-PC flows were obtained at the proximal segments of the MPA, RPA, and LPA. The stroke volume index (SVI), regurgitation fraction (RF), and PSV measured by 4D-CMR were compared to 2D-PC flow. The SVI across the PAs was nearly similar between both methods (P = 0.179 for MPA, 0.218 for RPA, and 0.091 for LPA). However, the RF was significantly higher by 4D-CMR in comparison to 2D-PC flow (P = 0.027 for MPA, 0.039 for RPA, and 0.046 for LPA). The PSV as well was significantly higher by 4D-CMR flow (P = 0.003 for MPA, < 0.001 for RPA, and 0.002 for LPA). The Bland-Altman plots showed a good agreement between 4D-CMR and 2D-PC flow for the SVI, RF, and PSV across the pulmonary arteries. Conclusion A good agreement existed between the two studied methods regarding pulmonary flow measurements. Because of its major advantage of performing a comprehensive flow assessment in a shorter time, 4D-CMR flow plays an important role in the assessment of patients with complex CHD especially in the pediatric group.

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Section: Discussionsupporting

confidence: 90%

Assessment of flow pattern of right ventricle outflow and pulmonary arteries in surgically corrected tetralogy of Fallot patients by four-dimensional cardiac magnetic resonance flow

et al. 2020

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“…More than half the included rTOF studies used gadolinium, often because it was required for other reasons. T1 shortening contrast agents enable larger flip angles and reduced signal loss due to saturation in 4D flow acquisitions, and are commonly available in centers [24]. This agrees with the consensus statement [16]; however, timing of administration and type used may cause variable outcomes.…”

Section: Contrast Enhancementsupporting

confidence: 74%

“…Internal validation of stroke volumes at different levels of the same vessel at different levels in the ascending aorta and pulmonary trunk did not show significant differences [27]. However, there was a significantly higher variation in patients compared to healthy subjects, which may be due to patients having complex flow patterns leading to signal loss in the presence of some turbulent flows [24].…”

Section: Stroke Volumementioning

confidence: 87%

“…ii) Validation of new methods (mainly acceleration techniques) of 4D flow acquisition [9,20,21], for example comparing under-sampled data against fully sampled data [22]. iii) Validation against 2D CMR along with qualitative and quantitative description of blood flow [9][10][11][21][22][23][24][25][26][27][28][29][30]. iv) Identification of novel flow features such as vortices in the right side of the heart in rTOF patients compared with normal populations [12,19] and the effects of different surgeries on vortices in the heart [18] as early prognostic factors in ventricular changes and valvular malfunction.…”

Section: Aim Of the Studiesmentioning

confidence: 99%

“…A variety of software packages were used across studies; some in-house tools have been developed [28,42] but more recent studies typically used commercially available packages [24,25] that are either provided on the scanner or on post-processing workstations, utilizing the DICOM format. Consistency between vendors is highly recommended but currently not well characterized.…”

Section: Softwarementioning

confidence: 99%

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Four-dimensional flow cardiovascular magnetic resonance in tetralogy of Fallot: a systematic review

Elsayed

Gilbert

Scadeng

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Patients with repaired Tetralogy of Fallot (rTOF) often develop cardiovascular dysfunction and require regular imaging to evaluate deterioration and time interventions such as pulmonary valve replacement. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) enables detailed assessment of flow characteristics in all chambers and great vessels. We performed a systematic review of intra-cardiac 4D flow applications in rTOF patients, to examine clinical utility and highlight optimal methods for evaluating rTOF patients. Methods A comprehensive literature search was undertaken in March 2020 on Google Scholar and Scopus. A modified version of the Critical Appraisal Skills Programme (CASP) tool was used to assess and score the applicability of each study. Important clinical outcomes were assessed including similarities and differences. Results Of the 635 articles identified, 26 studies met eligibility for systematic review. None of these were below 59% applicability on the modified CASP score. Studies could be broadly classified into four groups: (i) pilot studies, (ii) development of new acquisition methods, (iii) validation and (vi) identification of novel flow features. Quantitative comparison with other modalities included 2D phase contrast CMR (13 studies) and echocardiography (4 studies). The 4D flow study applications included stroke volume (18/26;69%), regurgitant fraction (16/26;62%), relative branch pulmonary artery flow(4/26;15%), systolic peak velocity (9/26;35%), systemic/pulmonary total flow ratio (6/26;23%), end diastolic and end systolic volume (5/26;19%), kinetic energy (5/26;19%) and vorticity (2/26;8%). Conclusions 4D flow CMR shows potential in rTOF assessment, particularly in retrospective valve tracking for flow evaluation, velocity profiling, intra-cardiac kinetic energy quantification, and vortex visualization. Protocols should be targeted to pathology. Prospective, randomized, multi-centered studies are required to validate these new characteristics and establish their clinical use.

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Four‐Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review

Doyle¹,

Orr²,

Greenwood³

et al. 2021

Magnetic Resonance Imaging

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Four‐dimensional (4D) flow magnetic resonance imaging (MRI) allows multidirectional quantification of blood flow in the heart and great vessels. Comparability of the technique to the current reference standards of flow assessment—two‐dimensional (2D) flow MRI and Doppler echocardiography—varies in the literature. Image acquisition parameters likely impact upon the accuracy and reproducibility of 4D flow MRI. We therefore sought to review the current literature on 4D flow MRI in the heart and great vessels, in comparison to 2D flow MRI, Doppler echocardiography, and invasive catheterization. Using a predefined search strategy and inclusion and exclusion criteria, the databases EMBASE and Medline were searched in January 2021 for peer‐reviewed research articles comparing cardiac 4D flow MRI to 2D flow MRI, Doppler echocardiography and/or invasive catheterization. The data from all relevant articles were assimilated and analyzed using Mann–Whitney U and chi χ2 test. Forty‐four manuscripts met the eligibility criteria and were included in the review. The review showed agreement of 4D flow MRI to the reference standard methods of flow assessment, particular in the measurement of peak velocity and stroke volume in 55% of manuscripts. The use of valve tracking significantly improves agreement between 4D flow MRI and the reference modalities (79% matching with the use of valve tracking vs. 50% without, P = 0.04). This review highlights that the impact of acquisition parameters on 4D flow MRI accuracy is multifactorial. It is therefore important that each center conducts its own quality assurance prior to using 4D flow MRI for clinical decision‐making. Level of Evidence 2 Technical Efficacy Stage 2

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4D flow vs. 2D cardiac MRI for the evaluation of pulmonary regurgitation and ventricular volume in repaired tetralogy of Fallot: a retrospective case control study

Cited by 23 publications

References 46 publications

Assessment of flow pattern of right ventricle outflow and pulmonary arteries in surgically corrected tetralogy of Fallot patients by four-dimensional cardiac magnetic resonance flow

Assessment of flow pattern of right ventricle outflow and pulmonary arteries in surgically corrected tetralogy of Fallot patients by four-dimensional cardiac magnetic resonance flow

Four-dimensional flow cardiovascular magnetic resonance in tetralogy of Fallot: a systematic review

Four‐Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review

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