1
|
Al Kindi FA, Al Kindi H, Maddali MM, Al Farqani A, Al Alawi K, Al Balushi A, Al Ghafri M, Khalil S, Kumar S. Comparing flow and pulmonary artery growth post-patent ductus arteriosus stenting in patients with ductal-dependent pulmonary flow using 4D magnetic resonance imaging. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae044. [PMID: 39224104 PMCID: PMC11367953 DOI: 10.1093/ehjimp/qyae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/13/2024] [Indexed: 09/04/2024]
Abstract
Aims The 4D magnetic resonance imaging (4D-flow MRI) provides a qualitative and quantitative assessment of cardiovascular structures and processes. 4D-flow MRI was used to study pulmonary flow in post-patent ductus arteriosus (PDA) stent insertion in duct-dependent pulmonary flow neonates at baseline (PDA stent insertion) and after 6 months, and also, to evaluate the effect of flow dynamics on the growth of pulmonary arteries (PAs). Methods and results This prospective observational study included neonates with ductus arteriosus-dependent pulmonary circulation who underwent ductal stenting between June 2021 and November 2022. Cardiac 4D-flow MRI and magnetic resonance angiography were conducted in two phases; after the deployment of the PDA stent during the neonatal period and after 6 months from stent deployment. Eight neonates were recruited, but only five completed both scans. A total of 10 PAs were evaluated during each phase. The median left PA (LPA) and right PA (RPA) diameters and indexed flow for LPA and RPA were evaluated. The growth rate of LPA was observed to be lower than that of RPA (percentage diameter increase: 74 vs. 153%). LPA Z-score was lower than RPA. Indexed flow in both LPA and RPA showed a reduction in the 6-month scan, which was consistent with reduced stent patency. Conclusion 4D-flow cardiac MRI showed different growth rates and reduced flow between LPA and RPA post-PDA stent. These insights can aid in future management decisions.
Collapse
Affiliation(s)
- Faiza A Al Kindi
- The Radiology Department, The Royal Hospital, P.O. Box 1331, Ghala St, 111 Muscat, Oman
| | - Hamood Al Kindi
- The National Heart Center, The Royal Hospital, P.O. Box 393, 18 November St, 100 Muscat, Oman
| | - Madan Mohan Maddali
- The National Heart Center, The Royal Hospital, P.O. Box 393, 18 November St, 100 Muscat, Oman
| | - Abdullah Al Farqani
- The National Heart Center, The Royal Hospital, P.O. Box 393, 18 November St, 100 Muscat, Oman
| | - Khalid Al Alawi
- The National Heart Center, The Royal Hospital, P.O. Box 393, 18 November St, 100 Muscat, Oman
| | - Abdullah Al Balushi
- The National Heart Center, The Royal Hospital, P.O. Box 393, 18 November St, 100 Muscat, Oman
| | - Mohammed Al Ghafri
- The National Heart Center, The Royal Hospital, P.O. Box 393, 18 November St, 100 Muscat, Oman
| | - Sahar Khalil
- The Radiology Department, The Royal Hospital, P.O. Box 1331, Ghala St, 111 Muscat, Oman
| | - Satish Kumar
- Centre of Studies and Research, Ministry of Health, P.O. Box 393, 100 Muscat, Oman
| |
Collapse
|
2
|
Lawley CM, Broadhouse KM, Callaghan FM, Winlaw DS, Figtree GA, Grieve SM. 4D flow magnetic resonance imaging: role in pediatric congenital heart disease. Asian Cardiovasc Thorac Ann 2017; 26:28-37. [PMID: 28185475 DOI: 10.1177/0218492317694248] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Imaging-based evaluation of cardiac structure and function remains paramount in the diagnosis and monitoring of congenital heart disease in childhood. Accurate measurements of intra- and extracardiac hemodynamics are required to inform decision making, allowing planned timing of interventions prior to deterioration of cardiac function. Four-dimensional flow magnetic resonance imaging is a nonionizing noninvasive technology that allows accurate and reproducible delineation of blood flow at any anatomical location within the imaging volume of interest, and also permits derivation of physiological parameters such as kinetic energy and wall shear stress. Four-dimensional flow is the focus of a great deal of attention in adult medicine, however, the translation of this imaging technique into the pediatric population has been limited to date. A more broad-scaled application of 4-dimensional flow in pediatric congenital heart disease stands to increase our fundamental understanding of the cause and significance of abnormal blood flow patterns, may improve risk stratification, and inform the design and use of surgical and percutaneous correction techniques. This paper seeks to outline the application of 4-dimensional flow in the assessment and management of the pediatric population affected by congenital heart disease.
Collapse
Affiliation(s)
- Claire M Lawley
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia.,3 Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Kathryn M Broadhouse
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Fraser M Callaghan
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - David S Winlaw
- 4 Heart Centre for Children & University of Sydney, The Children's Hospital at Westmead, Sydney, Australia
| | - Gemma A Figtree
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia
| | - Stuart M Grieve
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia.,5 Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
3
|
Hirtler D, Garcia J, Barker AJ, Geiger J. Assessment of intracardiac flow and vorticity in the right heart of patients after repair of tetralogy of Fallot by flow-sensitive 4D MRI. Eur Radiol 2016; 26:3598-607. [PMID: 26747260 DOI: 10.1007/s00330-015-4186-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/22/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To comprehensively and quantitatively analyse flow and vorticity in the right heart of patients after repair of tetralogy of Fallot (rTOF) compared with healthy volunteers. METHODS Time-resolved flow-sensitive 4D MRI was acquired in 24 rTOF patients and 12 volunteers. Qualitative flow evaluation was based on consensus reading of two observers. Quantitative analysis included segmentation of the right atrium (RA) and ventricle (RV) in a four-chamber view to extract volumes and regional haemodynamic information for computation of regional mean and peak vorticity. RESULTS Right heart intra-atrial, intraventricular and outflow tract flow patterns differed considerably between rTOF patients and volunteers. Peak RA and mean RV vorticity was significantly higher in patients (p = 0.02/0.05). Significant negative correlations were found between patients' maximum and mean RV and RA vorticity and ventricular volumes (p < 0.05). The main pulmonary artery (MPA) regurgitant flow was associated with higher RA and RV vorticity, which was significant for RA maximum and RV mean vorticity (p = 0.01/0.03). CONCLUSION The calculation of vorticity based on 4D flow data is an alternative approach to assess intracardiac flow changes in rTOF patients compared with qualitative flow visualization. Alterations in intracardiac vorticity could be relevant with regard to the development of RV dilation and impaired function. KEY POINTS • 4D flow MRI with vorticity calculation enables a novel approach to assess intracardiac flow. • Significantly higher intracardiac vorticity occurred in patients after repair of tetralogy of Fallot. • Regurgitant flow in the main pulmonary artery is associated with higher right heart vorticity.
Collapse
Affiliation(s)
- Daniel Hirtler
- Department of Congenital Heart Defects and Pediatric Cardiology (Heart Center, University of Freiburg), University Hospital Freiburg, Mathildenstr. 1, 79106, Freiburg, Germany.
| | - Julio Garcia
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alex J Barker
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia Geiger
- Department of Radiology, University Childrens' Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
4-D flow magnetic resonance imaging: blood flow quantification compared to 2-D phase-contrast magnetic resonance imaging and Doppler echocardiography. Pediatr Radiol 2015; 45:804-13. [PMID: 25487721 PMCID: PMC4450116 DOI: 10.1007/s00247-014-3246-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Doppler echocardiography (echo) is the reference standard for blood flow velocity analysis, and two-dimensional (2-D) phase-contrast magnetic resonance imaging (MRI) is considered the reference standard for quantitative blood flow assessment. However, both clinical standard-of-care techniques are limited by 2-D acquisitions and single-direction velocity encoding and may make them inadequate to assess the complex three-dimensional hemodynamics seen in congenital heart disease. Four-dimensional flow MRI (4-D flow) enables qualitative and quantitative analysis of complex blood flow in the heart and great arteries. OBJECTIVES The objectives of this study are to compare 4-D flow with 2-D phase-contrast MRI for quantification of aortic and pulmonary flow and to evaluate the advantage of 4-D flow-based volumetric flow analysis compared to 2-D phase-contrast MRI and echo for peak velocity assessment in children and young adults. MATERIALS AND METHODS Two-dimensional phase-contrast MRI of the aortic root, main pulmonary artery (MPA), and right and left pulmonary arteries (RPA, LPA) and 4-D flow with volumetric coverage of the aorta and pulmonary arteries were performed in 50 patients (mean age: 13.1 ± 6.4 years). Four-dimensional flow analyses included calculation of net flow and regurgitant fraction with 4-D flow analysis planes similarly positioned to 2-D planes. In addition, 4-D flow volumetric assessment of aortic root/ascending aorta and MPA peak velocities was performed and compared to 2-D phase-contrast MRI and echo. RESULTS Excellent correlation and agreement were found between 2-D phase-contrast MRI and 4-D flow for net flow (r = 0.97, P < 0.001) and excellent correlation with good agreement was found for regurgitant fraction (r = 0.88, P < 0.001) in all vessels. Two-dimensional phase-contrast MRI significantly underestimated aortic (P = 0.032) and MPA (P < 0.001) peak velocities compared to echo, while volumetric 4-D flow analysis resulted in higher (aortic: P = 0.001) or similar (MPA: P = 0.98) peak velocities relative to echo. CONCLUSION Excellent flow parameter agreement between 2-D phase-contrast MRI and 4-D flow and the improved volumetric 4-D flow velocity analysis relative to echo suggests that 4-D flow has the potential to become a clinical alternative to 2-D phase-contrast MRI.
Collapse
|
5
|
Vasanawala SS, Hanneman K, Alley MT, Hsiao A. Congenital heart disease assessment with 4D flow MRI. J Magn Reson Imaging 2015; 42:870-86. [PMID: 25708923 DOI: 10.1002/jmri.24856] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 11/10/2022] Open
Abstract
With improvements in surgical and medical management, patients with congenital heart disease (CHD) are often living well into adulthood. MRI provides critical data for diagnosis and monitoring of these patients, yielding information on cardiac anatomy, blood flow, and cardiac function. Though historically these exams have been complex and lengthy, four-dimensional (4D) flow is emerging as a single fast technique for comprehensive assessment of CHD. The 4D flow consists of a volumetric time-resolved acquisition that is gated to the cardiac cycle, providing a time-varying vector field of blood flow as well as registered anatomic images. In this article, we provide an overview of MRI evaluation of congenital heart disease by means of example of three relatively common representative conditions: tetralogy of Fallot, aortic coarctation, and anomalous pulmonary venous drainage. Then 4D flow data acquisition, data correction, and postprocessing techniques are reviewed. We conclude with several examples that highlight the comprehensive nature of the evaluation of congenital heart disease with 4D flow.
Collapse
Affiliation(s)
| | - Kate Hanneman
- Department of Radiology, University of California, San Diego, San Diego, California, USA
| | - Marcus T Alley
- Department of Radiology, Stanford University, Stanford, California, USA
| | | |
Collapse
|
6
|
Allen BD, van Ooij P, Barker AJ, Carr M, Gabbour M, Schnell S, Jarvis KB, Carr JC, Markl M, Rigsby C, Robinson JD. Thoracic aorta 3D hemodynamics in pediatric and young adult patients with bicuspid aortic valve. J Magn Reson Imaging 2015; 42:954-63. [PMID: 25644073 DOI: 10.1002/jmri.24847] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To evaluate the 3D hemodynamics in the thoracic aorta of pediatric and young adult bicuspid aortic valve (BAV) patients. METHODS 4D flow MRI was performed in 30 pediatric and young adult BAV patients (age: 13.9 ± 4.4 (range: [3.4, 20.7]) years old, M:F = 17:13) as part of this Institutional Review Board-approved study. Nomogram-based aortic root Z-scores were calculated to assess aortic dilatation and degree of aortic stenosis (AS) severity was assessed on MRI. Data analysis included calculation of time-averaged systolic 3D wall shear stress (WSSsys ) along the entire aorta wall, and regional quantification of maximum and mean WSSsys and peak systolic velocity (velsys ) in the ascending aorta (AAo), arch, and descending aorta (DAo). The 4D flow MRI AAo velsys was also compared with echocardiography peak velocity measurements. RESULTS There was a positive correlation with both mean and max AAo WSSsys and peak AAo velsys (mean: r = 0.84, P < 0.001, max: r = 0.94, P < 0.001) and AS (mean: rS = 0.43, P = 0.02, max: rS = 0.70, P < 0.001). AAo peak velocity was significantly higher when measured with echo compared with 4D flow MRI (2.1 ± 0.98 m/s versus 1.27 ± 0.49 m/s, P < 0.001). CONCLUSION In pediatric and young adult patients with BAV, AS and peak ascending aorta velocity are associated with increased AAo WSS, while aortic dilation, age, and body surface area do not significantly impact AAo hemodynamics. Prospective studies are required to establish the role of WSS as a risk-stratification tool in these patients.
Collapse
Affiliation(s)
- Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pim van Ooij
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maya Gabbour
- Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kelly B Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
| | - Cynthia Rigsby
- Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Joshua D Robinson
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
7
|
Guibert R, McLeod K, Caiazzo A, Mansi T, Fernández MA, Sermesant M, Pennec X, Vignon-Clementel IE, Boudjemline Y, Gerbeau JF. Group-wise construction of reduced models for understanding and characterization of pulmonary blood flows from medical images. Med Image Anal 2014; 18:63-82. [DOI: 10.1016/j.media.2013.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/15/2013] [Accepted: 09/19/2013] [Indexed: 11/27/2022]
|
8
|
Postoperative pulmonary and aortic 3D haemodynamics in patients after repair of transposition of the great arteries. Eur Radiol 2013; 24:200-8. [PMID: 23995974 DOI: 10.1007/s00330-013-2998-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 07/30/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To characterise aortic and pulmonary haemodynamics and investigate the correlation with post-surgical anatomy in patients with dextro-transposition of the great arteries (d-TGA). METHODS Four-dimensional (4D) MRI was performed in 17 patients after switch repair of TGA and 12 healthy controls (age, 11.9 ± 5.4 vs 23.3 ± 1.6 years). Patients were divided according to the pulmonary trunk (TP) position in relation to the ascending aorta (AAo): anterior (n = 10) and right/left anterior position (n = 7). Analysis included visual grading (ranking 0-2) of pulmonary and aortic vortical and helical flow, flow velocity quantification, blood-flow distribution to the right and left pulmonary arteries (flow ratio rPA:lPA), and vessel lumen areas. RESULTS Anterior TP position was associated with increased vortices in six out of ten patients compared with right anterior TP position (one out of seven) and controls (none). Reduced systolic lPA and TP lumina in patients resulted in significantly increased peak systolic velocities (P < 0.001). Flow ratio rPA:lPA was more heterogeneous in patients (rPA:lPA = 1.56 ± 0.78 vs volunteers 1.09 ± 0.15; P < 0.05) with predominant flow to the rPA. Eleven patients presented increased helices in the AAo (grade 1.6). CONCLUSIONS Evaluation of post-surgical haemodynamics in TGA patients revealed increased vortical flow for anterior TP position, asymmetric flow and increased systolic flow velocity in the pulmonary arteries owing to reduced vascular lumina. KEY POINTS • 3D phase contrast MRI with velocity encoding (4D MRI) has numerous cardiovascular applications • 4D MRI demonstrates postoperative haemodynamics following surgery for transposition of the great arteries • Flow visualisation depicted enhanced pulmonary vortices in the anterior pulmonary trunk • Narrow pulmonary arterial systolic lumina resulted in increased peak systolic velocities.
Collapse
|