Comparison of 4D flow and 2D PC MRI blood flow quantification in children and young adults with congenital heart disease

Gabbour, Maya; Rigsby, Cynthia K.; Markl, Michael; Schnell, Susanne; Jarvis, Kelly; Freitas, Roger A de; Popescu, Andrada; Robinson, Joshua D.

doi:10.1186/1532-429x-15-s1-e90

Cited by 8 publications

(12 citation statements)

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“…This finding is in accordance with recent studies conducted by other groups comparing 4D-flow MRI and TTE in a pediatric population, finding relatively large limits of agreement between both imaging techniques. 22 Differences between 4D-flow MRI and TTE may be explained by two factors. First, the relatively large voxel size (2.5 3 2.5 3 2.5 mm 3 ) used in the acquisition of the 4D-flow MRI scan may result in underestimation of the peak velocity due to voxel dephasing, whereas echocardiography may result in underestimation due to misalignment of the measurement plane or poor acoustic windows.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve stenosis and aortic diameters determine the extent of increased wall shear stress in bicuspid aortic valve disease

Farag

Ooij

Planken

et al. 2018

Magnetic Resonance Imaging

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BackgroundUse of 4‐dimensional flow magnetic resonance imaging (4D‐flow MRI) derived wall shear stress (WSS) heat maps enables identification of regions in the ascending aorta with increased WSS. These regions are subject to dysregulation of the extracellular matrix and elastic fiber degeneration, which is associated with aortic dilatation and dissection.PurposeTo evaluate the effect of the presence of aortic valve stenosis and the aortic diameter on the peak WSS and surface area of increased WSS in the ascending aorta.Study TypeProspective.SubjectsIn all, 48 bicuspid aortic valve (BAV) patients (38.1 ± 12.4 years) and 25 age‐ and gender‐matched healthy individuals.Field Strength/SequenceTime‐resolved 3D phase contrast MRI with three‐directional velocity encoding at 3.0T.AssessmentPeak systolic velocity, WSS, and aortic diameters were assessed in the ascending aorta and 3D heat maps were used to identify regions with elevated WSS.Statistical TestsComparisons between groups were performed by t‐tests. Correlations were investigated by univariate and multivariate regression analysis.ResultsElevated WSS was present in 15 ± 11% (range; 1–35%) of the surface area of the ascending aorta of BAV patients with aortic valve stenosis (AS) (n = 10) and in 6 ± 8% (range; 0–31%) of the ascending aorta of BAV patients without AS (P = 0.005). The mid‐ascending aortic diameter negatively correlated with the peak ascending aortic WSS (R = –0.413, P = 0.004) and the surface area of elevated WSS (R = –0.419, P = 0.003). Multivariate linear regression analysis yielded that the height of peak WSS and the amount of elevated WSS depended individually on the presence of aortic valve stenosis and the diameter of the ascending aorta.Data ConclusionThe extent of increased WSS in the ascending aorta of BAV patients depends on the presence of aortic valve stenosis and aortic dilatation and is most pronounced in the presence of AS and a nondilated ascending aorta. Level of Evidence: 2 Technical Efficacy: Stage 2J. MAGN. RESON. IMAGING 2018;48:522–530.

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Section: Discussionmentioning

confidence: 99%

Aortic valve stenosis and aortic diameters determine the extent of increased wall shear stress in bicuspid aortic valve disease

Farag

Ooij

Planken

et al. 2018

Magnetic Resonance Imaging

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“…Studies could be broadly classified into: i) Pilot studies, qualitative evaluations [18,19] and preliminary quantification studies. 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].…”

Section: Aim Of the Studiesmentioning

confidence: 99%

“…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%

“…The average mean of differences represented < 1% of the overall mean value for arterial and < 3% for venous stroke volume [9, 11, Other studies found good internal consistency through indirect measurement of cardiac output using stroke volume from cine slice planimetry. Nevertheless, some studies reported some significant bias, for example Giese et al [21]. reported an underestimation of stroke volume by 2.5 ± 8.4 ml with 4D flow corresponding to 5.6 ± 14.9% with respect to the stroke volumes derived from the 2D flow datasets.…”

Section: Stroke Volumementioning

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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“…Hsiao et al 16 found that 4D flow MRI and echocardiography presented good interobserver correlation, with good agreement in assessing valvular regurgitation. Flow and velocity measurements obtained by 4D flow MRI in mediastinal vessels have been successfully compared in healthy patients16 and in patients with congenital heart disease 17…”

Section: Introductionmentioning

confidence: 99%

Clinical use of 4D flow MRI for quantification of aortic regurgitation

et al. 2020

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ObjectiveThe main objective of the present study was to compare the use of four-dimensional (4D) flow MRI with the habitual sequence (two-dimensional phase-contrast (2DPC) MRI) for the assessment of aortic regurgitation (AR) in the clinical routine.MethodsThis was a retrospective, observational cohort study of patients with varying grades of AR. For the purposes of the present study, we selected all the cases with a regurgitant fraction (RF)>5% as determined by 2DPC MRI (n=34). In all cases, both sequences (2DPC and 4D flow MRI) were acquired in a single session to ensure comparability. We compared the results of the two techniques by evaluating forward flow, regurgitant flow and regurgitation fraction. Then, the patients were divided into subgroups to determine if these factors had any influence on the measurements: aortic diameter (≤ vs >38 mm), valve anatomy (tricuspid vs bicuspid/quadricuspid), stenosis (gradient ≥15 vs <15) and region of interest location (aortic valve vs sinotubular junction).ResultsNo statistically significant differences were observed between the two techniques with Pearson’s correlation coefficients (r) of forward flow (r=0.826/p value<0001), regurgitant flow (r=0.866/p value<0001) and RF (r=0.761/p value<0001).ConclusionsThe findings of this study confirm the value of 4D flow MRI for grading AR in clinical practice with an excellent correlation with the standard technique (2DPC MRI).

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Comparison of 4D flow and 2D PC MRI blood flow quantification in children and young adults with congenital heart disease

Cited by 8 publications

References 0 publications

Aortic valve stenosis and aortic diameters determine the extent of increased wall shear stress in bicuspid aortic valve disease

Aortic valve stenosis and aortic diameters determine the extent of increased wall shear stress in bicuspid aortic valve disease

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

Clinical use of 4D flow MRI for quantification of aortic regurgitation

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