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Weiss EK, Baraboo J, Rigsby CK, Robinson JD, Ma L, Falcão MBL, Roy CW, Stuber M, Markl M. Respiratory-resolved 5D Flow MRI: in-vivo validation and respiratory dependent flow changes in healthy volunteers and patients with congenital heart disease. J Cardiovasc Magn Reson 2024:101077. [PMID: 39098573 DOI: 10.1016/j.jocmr.2024.101077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 06/13/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND This study aimed to validate respiratory-resolved 5D flow MRI against real-time 2D phase contrast MRI, assess the impact of number of respiratory states, and measure the impact of respiration on hemodynamics in congenital heart disease (CHD) patients. METHODS Respiratory-resolved 5D flow MRI derived net and peak flow measurements were compared to real-time 2D phase contrast MRI derived measurements in 10 healthy volunteers. Pulmonary to systemic flow ratios (Qp:Qs) were measured in 19 CHD patients and aortopulmonary collateral burden was measured in 5 Fontan patients. Additionally, the impact of number of respiratory states on measured respiratory-driven net flow changes was investigated in 10 healthy volunteers and 19 CHD patients (shunt physiology, n=11, single ventricle disease (SVD), n=8). RESULTS There was good agreement between 5D flow MRI and real-time 2D phase contrast derived net and peak flow. Respiratory driven changes had good correlation (rho=0.64, p<0.001). In healthy volunteers, fewer than four respiratory states reduced measured respiratory driven flow changes in veins (5.2mL/cycle, p<0.001) and arteries (1.7mL/cycle, p=0.05). Respiration drove substantial venous net flow changes in SVD (64% change) and shunt patients (57% change). Respiration had significantly greater impact in SVD patients compared to shunt patients in the right and left pulmonary arteries (46% vs 15%, p=0.003 & 59% vs 20%, p=0.002). Qp:Qs varied by 37±24% over respiration in SVD patients and 12±20% in shunt patients. Aortopulmonary collateral burden varied by 118±84% over respiration in Fontan patients. The smallest collateral burden was measured during active inspiration in all patients and the greatest burden was during active expiration in 4 of 5 patients. Reduced respiratory resolution blunted measured flow changes in the caval veins of shunt and SVD patients (p<0.005). CONCLUSIONS Respiratory-resolved 5D flow MRI measurements agree with real-time 2D phase contrast. Venous measurements are sensitive to number of respiratory states, whereas arterial measurements are more robust. Respiration has substantial impact on caval vein flow, Qp:Qs, and collateral burden in CHD patients.
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Affiliation(s)
- Elizabeth K Weiss
- Department of Radiology, Northwestern University, Chicago, IL USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL USA.
| | - Justin Baraboo
- Department of Radiology, Northwestern University, Chicago, IL USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL USA
| | - Cynthia K Rigsby
- Department of Radiology, Northwestern University, Chicago, IL USA; Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, IL, USA
| | - Joshua D Robinson
- Department of Cardiology, Ann & Robert Lurie Children's Hospital, Chicago, IL, USA
| | - Liliana Ma
- Department of Radiology, Northwestern University, Chicago, IL USA
| | - Mariana B L Falcão
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Christopher W Roy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL USA
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2
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Lagerstrand K, Nyström A, Svensson PA, De Lange C, Dangardt F. Accurate quantification of pulmonary perfusion ratio in children with congenital heart disease using partial volume corrected 4D flow cardiac magnetic resonance. Front Pediatr 2024; 12:1339679. [PMID: 38818350 PMCID: PMC11137306 DOI: 10.3389/fped.2024.1339679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Background In children with congenital heart disease (CHD), lung scintigraphy is the reference standard for evaluation of pulmonary perfusion. 4D flow CMR offers a non-ionizing alternative. Due to the intrinsic limitation in the spatial resolution, however, 4D flow may display clinically unacceptable differences compared to the reference standard. This case study aims to highlight the importance of correcting for such partial volume errors to accurately evaluate pulmonary perfusion in small pulmonary arteries. Methods Children with CHD, mainly those with transposition of the great arteries or tetralogy-of-Fallot, referred to CMR from 2020 to 2022 at our clinic, were retrospectively reviewed; n = 37. All patients had been examined with a free breathing, motion-corrected 4D flow protocol. Comparison in pulmonary perfusion (PPR: relative flow through right and left pulmonary arteries) with scintigraphy were performed both for 4D flow before and after partial volume correction. Results Patients with large pulmonary arteries, 76%, displayed small differences in PPR between modalities (<20%), while patients with arteries of only a few pixels, 24%, displayed differences up to 178%, depending on the relative difference in size between the right and left pulmonary artery. Differences were effectively reduced after partial volume correction (<21%). Conclusion The present report shows that 4D flow is a promising tool to accurately evaluate the pulmonary perfusion in children with CHD, but that partial volume correction is warranted to overcome its limitation in the spatial resolution. Without such correction, lung scintigraphy is still recommended to ensure high diagnostic certainty in children with small pulmonary arteries.
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Affiliation(s)
- Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Nyström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pär-Arne Svensson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotte De Lange
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frida Dangardt
- Children's Heart Center, The Queen Silvia Children's Hospital, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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3
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Bissell MM, Raimondi F, Ait Ali L, Allen BD, Barker AJ, Bolger A, Burris N, Carhäll CJ, Collins JD, Ebbers T, Francois CJ, Frydrychowicz A, Garg P, Geiger J, Ha H, Hennemuth A, Hope MD, Hsiao A, Johnson K, Kozerke S, Ma LE, Markl M, Martins D, Messina M, Oechtering TH, van Ooij P, Rigsby C, Rodriguez-Palomares J, Roest AAW, Roldán-Alzate A, Schnell S, Sotelo J, Stuber M, Syed AB, Töger J, van der Geest R, Westenberg J, Zhong L, Zhong Y, Wieben O, Dyverfeldt P. 4D Flow cardiovascular magnetic resonance consensus statement: 2023 update. J Cardiovasc Magn Reson 2023; 25:40. [PMID: 37474977 PMCID: PMC10357639 DOI: 10.1186/s12968-023-00942-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.
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Affiliation(s)
- Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9NL, UK.
| | | | - Lamia Ait Ali
- Institute of Clinical Physiology CNR, Massa, Italy
- Foundation CNR Tuscany Region G. Monasterio, Massa, Italy
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, USA
| | - Ann Bolger
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nicholas Burris
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Carl-Johan Carhäll
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Albert Hsiao
- Department of Radiology, University of California, San Diego, CA, USA
| | - Kevin Johnson
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Liliana E Ma
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duarte Martins
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marci Messina
- Department of Radiology, Northwestern Medicine, Chicago, IL, USA
| | - Thekla H Oechtering
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Pim van Ooij
- Department of Radiology & Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cynthia Rigsby
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jose Rodriguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d´Hebron,Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red-CV, CIBER CV, Madrid, Spain
| | - Arno A W Roest
- Department of Pediatric Cardiology, Willem-Alexander's Children Hospital, Leiden University Medical Center and Center for Congenital Heart Defects Amsterdam-Leiden, Leiden, The Netherlands
| | | | - Susanne Schnell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Physics, Institute of Physics, University of Greifswald, Greifswald, Germany
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering - iHEALTH, Santiago, Chile
| | - Matthias Stuber
- Département de Radiologie Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ali B Syed
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rob van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Westenberg
- CardioVascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Zhong
- National Heart Centre Singapore, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yumin Zhong
- Department of Radiology, School of Medicine, Shanghai Children's Medical Center Affiliated With Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Oliver Wieben
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Petter Dyverfeldt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Sophocleous F, Delchev K, De Garate E, Hamilton MCK, Caputo M, Bucciarelli-Ducci C, Biglino G. Feasibility of Wave Intensity Analysis from 4D Cardiovascular Magnetic Resonance Imaging Data. Bioengineering (Basel) 2023; 10:662. [PMID: 37370593 DOI: 10.3390/bioengineering10060662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023] Open
Abstract
Congenital heart defects (CHD) introduce haemodynamic changes; e.g., bicuspid aortic valve (BAV) presents a turbulent helical flow, which activates aortic pathological processes. Flow quantification is crucial for diagnostics and to plan corrective strategies. Multiple imaging modalities exist, with phase contrast magnetic resonance imaging (PC-MRI) being the current gold standard; however, multiple predetermined site measurements may be required, while 4D MRI allows for measurements of area (A) and velocity (U) in all spatial dimensions, acquiring a single volume and enabling a retrospective analysis at multiple locations. We assessed the feasibility of gathering hemodynamic insight into aortic hemodynamics by means of wave intensity analysis (WIA) derived from 4D MRI. Data were collected in n = 12 BAV patients and n = 7 healthy controls. Following data acquisition, WIA was successfully derived at three planes (ascending, thoracic and descending aorta) in all cases. The values of wave speed were physiological and, while the small sample limited any clinical interpretation of the results, the study shows the possibility of studying wave travel and wave reflection based on 4D MRI. Below, we demonstrate for the first time the feasibility of deriving wave intensity analysis from 4D flow data and open the door to research applications in different cardiovascular scenarios.
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Affiliation(s)
- Froso Sophocleous
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Kiril Delchev
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Estefania De Garate
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Mark C K Hamilton
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust, London UB9 6JH, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London WC2R 2LS, UK
| | - Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
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5
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Panayiotou HR, Mills LK, Broadbent DA, Shelley D, Scheffczik J, Olaru AM, Jin N, Greenwood JP, Michael H, Plein S, Bissell MM. Comprehensive Neonatal Cardiac, Feed and Wrap, Non-contrast, Non-sedated, Free-breathing Compressed Sensing 4D Flow MRI Assessment. J Magn Reson Imaging 2023; 57:789-799. [PMID: 35792484 DOI: 10.1002/jmri.28325] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cardiac MRI is an important imaging tool in congenital cardiac disease, but its use has been limited in the neonatal population as general anesthesia has been needed for breath-holding. Technological advances in four-dimensional (4D) flow MRI have now made nonsedated free-breathing acquisition protocols a viable clinical option, but the method requires prospective validation in neonates. PURPOSE To test the feasibility of compressed sensing (CS) 4D flow MRI in the neonatal population and to compare with standard previously validated two-dimensional (2D) phase-contrast (PC) flow MRI. STUDY TYPE Prospective, cohort, image quality. POPULATION A total of 14 healthy neonates (median [range] age: 2.5 [0-80] days; 8 male). FIELD STRENGTH AND SEQUENCE Noncontrast 2D cine gradient echo sequence with through-plane velocity encoding (PC) sequence and compressed sensing (CS) three-dimensional (3D), time-resolved, cine phase-contrast MRI with 3D velocity-encoding (4D flow MRI) at 3 T. ASSESSMENT Aortic 2D PC, and aortic, pulmonary trunk and superior vena cava CS 4D flow MRI were acquired using the feed and wrap technique (nonsedated) and quantified using commercially available software. Aortic flow and peak velocity were compared between methods. Internal consistency of 4D flow MRI was determined by comparing mean forward flow of the main pulmonary artery (MPA) vs. the sum of left and right pulmonary artery flows (LPA and RPA) and by comparing mean ascending aorta forward flow (AAo) vs. the sum of superior vena cava (SVC) and descending aorta flows (DAo). STATISTICAL TESTS Flow and peak-velocity comparisons were assessed using paired t-tests, with P < 0.05 considered significant, and Bland-Altman analysis. Interobserver and intraobserver agreement and internal consistency were analyzed by intraclass correlation co-efficient (ICC). RESULTS There was no statistically significant difference between ascending aortic forward flow between 2D PC and CS 4D Flow MRI (P = 0.26) with a bias of 0.11 mL (-0.59 to 0.82 mL) nor peak velocity (P = 0.11), with a bias of -5 cm/sec and (-26 to 16 cm/sec). There was excellent interobserver and intraobserver agreement for each vessel (interobserver ICC: AAo 1.00; DAo 0.94, SVC 0.90, MPA 0.99, RPA 0.98, LPA 0.96; intraobserver ICC: AAo 1.00; DAo 0.99, SVC 0.98, MPA 1.00, RPA 1.00, LPA 0.99). Internal consistency measures showed excellent agreement for both mean forward flow of main pulmonary artery vs. the sum of left and right pulmonary arteries (ICC: 0.95) and mean ascending aorta forward flow vs. the sum of superior vena cava and descending aorta flows (ICC: 1.00). CONCLUSION Sedation-free neonatal feed and wrap MRI is well tolerated and feasible. CS 4D flow MRI quantification is similar to validated 2D PC free-breathing imaging with excellent interobserver and intraobserver agreement. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | - Lily K Mills
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - David A Broadbent
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK.,Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Shelley
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Jutta Scheffczik
- Department of Anaesthesiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Ning Jin
- Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - John P Greenwood
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Helen Michael
- Department of Paediatric Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Sven Plein
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Malenka M Bissell
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK.,Department of Paediatric Cardiology, Leeds Teaching Hospitals NHS Trust, UK
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6
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Cherry M, Khatir Z, Khan A, Bissell M. The impact of 4D-Flow MRI spatial resolution on patient-specific CFD simulations of the thoracic aorta. Sci Rep 2022; 12:15128. [PMID: 36068322 PMCID: PMC9448751 DOI: 10.1038/s41598-022-19347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) is considered the gold standard of medical imaging technologies as it allows for accurate imaging of blood vessels. 4-Dimensional Flow Magnetic Resonance Imaging (4D-Flow MRI) is built on conventional MRI, and provides flow data in the three vector directions and a time resolved magnitude data set. As such it can be used to retrospectively calculate haemodynamic parameters of interest, such as Wall Shear Stress (WSS). However, multiple studies have indicated that a significant limitation of the imaging technique is the spatiotemporal resolution that is currently available. Recent advances have proposed and successfully integrated 4D-Flow MRI imaging techniques with Computational Fluid Dynamics (CFD) to produce patient-specific simulations that have the potential to aid in treatments,surgical decision making, and risk stratification. However, the consequences of using insufficient 4D-Flow MRI spatial resolutions on any patient-specific CFD simulations is currently unclear, despite being a recognised limitation. The research presented in this study aims to quantify the inaccuracies in patient-specific 4D-Flow MRI based CFD simulations that can be attributed to insufficient spatial resolutions when acquiring 4D-Flow MRI data. For this research, a patient has undergone four 4D-Flow MRI scans acquired at various isotropic spatial resolutions and patient-specific CFD simulations have subsequently been run using geometry and velocity data produced from each scan. It was found that compared to CFD simulations based on a \documentclass[12pt]{minimal}
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\begin{document}$$1.5\,{\text {mm}} \times 1.5\,{\text {mm}} \times 1.5\,{\text {mm}}$$\end{document}1.5mm×1.5mm×1.5mm, using a spatial resolution of \documentclass[12pt]{minimal}
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\begin{document}$$4\,{\text {mm}} \times 4\,{\text {mm}} \times 4\,{\text {mm}}$$\end{document}4mm×4mm×4mm substantially underestimated the maximum velocity magnitude at peak systole by \documentclass[12pt]{minimal}
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\begin{document}$$110.55\%$$\end{document}110.55%. The impacts of 4D-Flow MRI spatial resolution on WSS calculated from CFD simulations have been investigated and it has been shown that WSS is underestimated in CFD simulations that are based on a coarse 4D-Flow MRI spatial resolution. The authors have concluded that a minimum 4D-Flow MRI spatial resolution of \documentclass[12pt]{minimal}
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\begin{document}$$1.5\,{\text {mm}} \times 1.5\,{\text {mm}} \times 1.5\,{\text {mm}}$$\end{document}1.5mm×1.5mm×1.5mm must be used when acquiring 4D-Flow MRI data to perform patient-specific CFD simulations. A coarser spatial resolution will produce substantial differences within the flow field and geometry.
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Affiliation(s)
- Molly Cherry
- CDT in Fluid Dynamics, School of Computing, University of Leeds, Leeds, LS2 9JT, UK.
| | - Zinedine Khatir
- School of Engineering and the Built Environment, Birmingham City University, Birmingham, B4 7XG, UK.,School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Amirul Khan
- School of Civil Engineering, University of Leeds, Leeds, LS2 9JT, UK
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7
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Pace DF, Dalca AV, Brosch T, Geva T, Powell AJ, Weese J, Moghari MH, Golland P. Learned iterative segmentation of highly variable anatomy from limited data: Applications to whole heart segmentation for congenital heart disease. Med Image Anal 2022; 80:102469. [PMID: 35640385 PMCID: PMC9617683 DOI: 10.1016/j.media.2022.102469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/08/2023]
Abstract
Training deep learning models that segment an image in one step typically requires a large collection of manually annotated images that captures the anatomical variability in a cohort. This poses challenges when anatomical variability is extreme but training data is limited, as when segmenting cardiac structures in patients with congenital heart disease (CHD). In this paper, we propose an iterative segmentation model and show that it can be accurately learned from a small dataset. Implemented as a recurrent neural network, the model evolves a segmentation over multiple steps, from a single user click until reaching an automatically determined stopping point. We develop a novel loss function that evaluates the entire sequence of output segmentations, and use it to learn model parameters. Segmentations evolve predictably according to growth dynamics encapsulated by training data, which consists of images, partially completed segmentations, and the recommended next step. The user can easily refine the final segmentation by examining those that are earlier or later in the output sequence. Using a dataset of 3D cardiac MR scans from patients with a wide range of CHD types, we show that our iterative model offers better generalization to patients with the most severe heart malformations.
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Affiliation(s)
- Danielle F Pace
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA; A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Adrian V Dalca
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA; A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tom Brosch
- Philips Research Laboratories, Hamburg, Germany
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Mehdi H Moghari
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Polina Golland
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
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8
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Al Kindi F, Maddali MM, Al Balushi A, Al Kindi H. Evaluation of pulmonary blood flow in bilateral bidirectional Glenn shunts: value of 4‐D flow cardiac magnetic resonance in the evaluation of pulmonary artery confluence stenosis. Clin Case Rep 2022; 10:e6038. [PMID: 35865760 PMCID: PMC9291262 DOI: 10.1002/ccr3.6038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/21/2022] [Accepted: 06/22/2022] [Indexed: 11/07/2022] Open
Abstract
Bilateral bidirectional Glenn shunts are associated with the risk of developing pulmonary artery bifurcation stenosis, resulting in variable pulmonary blood flow to either lung. This could negatively impact the subsequent stages of the single ventricle palliation pathway. This report highlights the value of 4D flow sequence from the cardiac magnetic resonance imaging in demonstrating the pulmonary blood flow characteristics following a bilateral bidirectional Glenn procedure. Mapping the blood flow pattern and its quantification to each lung provide objective insights into the possible predisposing factors for the development of pulmonary bifurcation stenosis.
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Affiliation(s)
| | | | | | - Hamood Al Kindi
- National Heart Center, Royal Hospital Muscat Oman
- Division of Cardiothoracic Surgery, Department of Surgery Sultan Qaboos University Hospital Seeb Oman
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9
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Helmy S, Karim S. Multimodality imaging in aortic stenosis. Heart Views 2022; 23:22-32. [PMID: 35757450 PMCID: PMC9231538 DOI: 10.4103/heartviews.heartviews_32_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/03/2022] [Indexed: 12/02/2022] Open
Abstract
Aortic stenosis (AS) is the most common cardiac valve lesion in the adult population, with an incidence increasing as the population ages. Accurate assessment of AS severity is necessary for clinical decision-making. Echocardiography is currently the diagnostic method of choice for assessing and managing AS. Transthoracic echocardiography is usually sufficient in most situations. Transesophageal echocardiography and stress echocardiography may also be utilized when there is inadequate image quality and/or discordance in the results and the clinical presentation. There is a role for other imaging modalities such as cardiac computed tomography, magnetic resonance imaging, and catheterization in selected cases. The following describes in some detail the role of these modalities in the diagnosis and assessment of AS.
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10
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Woldendorp K, Doyle MP, Black D, Ng M, Keech A, Grieve SM, Bannon PG. Subclinical valve thrombosis in transcatheter aortic valve implantation: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2021; 162:1491-1499.e2. [DOI: 10.1016/j.jtcvs.2020.01.084] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 12/21/2019] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
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11
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Yao X, Hu L, Peng Y, Feng F, Ouyang R, Xie W, Wang Q, Sun A, Zhong Y. Right and left ventricular function and flow quantification in pediatric patients with repaired tetralogy of Fallot using four-dimensional flow magnetic resonance imaging. BMC Med Imaging 2021; 21:161. [PMID: 34719378 PMCID: PMC8559379 DOI: 10.1186/s12880-021-00693-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background To assess the accuracy and reproducibility of right ventricular (RV) and left ventricular (LV) function and flow measurements in children with repaired tetralogy of Fallot (rTOF) using four-dimensional (4D) flow, compared with conventional two-dimensional (2D) magnetic resonance imaging (MRI) sequences. Methods Thirty pediatric patients with rTOF were retrospectively enrolled to undergo 2D balanced steady-state free precession cine (2D b-SSFP cine), 2D phase contrast (PC), and 4D flow cardiac MRI. LV and RV volumes and flow in the ascending aorta (AAO) and main pulmonary artery (MPA) were quantified. Pearson’s or Spearman’s correlation tests, paired t-tests, the Wilcoxon signed-rank test, Bland–Altman analysis, and intraclass correlation coefficients (ICC) were performed. Results The 4D flow scan time was shorter compared with 2D sequences (P < 0.001). The biventricular volumes between 4D flow and 2D b-SSFP cine had no significant differences (P > 0.05), and showed strong correlations (r > 0.90, P < 0.001) and good consistency. The flow measurements of the AAO and MPA between 4D flow and 2D PC showed moderate to good correlations (r > 0.60, P < 0.001). There was good internal consistency in cardiac output. There was good intraobserver and interobserver biventricular function agreement (ICC > 0.85). Conclusions RV and LV function and flow quantification in pediatric patients with rTOF using 4D flow MRI can be measured accurately and reproducibly compared to those with conventional 2D sequences.
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Affiliation(s)
- Xiaofen Yao
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Yafeng Peng
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Fei Feng
- AI Imaging, GE Healthcare, No. 1 Huatuo Road, Shanghai, 201203, China
| | - Rongzhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Weihui Xie
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Qian Wang
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Aimin Sun
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China.
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12
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Gao Q, Liu X, Wang H, Wu P, Jin M, Wei R, Wang W, Niu Z, Zhao S, Li F. Optimization of 4D flow MRI velocity field in the aorta with divergence-free smoothing. Med Biol Eng Comput 2021; 59:2237-2252. [PMID: 34528164 DOI: 10.1007/s11517-021-02417-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Divergence-free smoothing with wall treatment (DFSwt) method is proposed for processing with four-dimensional (4D) flow magnetic resonance imaging (MRI) data of blood flows to enhance the quality of flow field with physical constraints. The new method satisfies the no-slip wall boundary condition and applies wall function of velocity profile for better estimating the velocity gradient in the near-wall region, and consequently improved wall shear stress (WSS) calculation against the issue of coarse resolution of 4D flow MRI. In the first testing case, blood flow field obtained from 4D flow MRI is well smoothed by DFSwt method. A great consistency is observed between the post-processed 4D flow MRI data and the computational fluid dynamics (CFD) data in the interested velocity field. WSS has an apparent improvement due to the proposed near-wall treatment with special wall function comparing to the result from original 4D flow MRI data or the DFS-processed data with no wall function. The other five cases also show the same performance that smoothed velocity field and improved WSS estimation are achieved on 4D flow MRI data optimized by DFSwt. The improvements will benefit the study of hemodynamics regarding the determination of location or the potential possibility of lesions.
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Affiliation(s)
- Qi Gao
- School of Aeronautics and Astronautics, Zhejiang University, Yuquan Campus, 38 Zheda Road, Xihu District, Hangzhou, 310027, China.
| | - Xingli Liu
- Hangzhou Shengshi Technology Co., Ltd., Hangzhou, China
| | - Hongping Wang
- The State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
| | - Peng Wu
- Artificial Organ Technology Lab, Bio-manufacturing Research Centre, School of Mechanical and Electric Engineering, Soochow University, Suzhou, China
| | - Mansu Jin
- Hangzhou Shengshi Technology Co., Ltd., Hangzhou, China
| | - RunJie Wei
- Hangzhou Shengshi Technology Co., Ltd., Hangzhou, China
| | - Wei Wang
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences & Fuwai Hospital; State Key Laboratory of Cardiovascular Disease, Peking Union Medical College, 167 Beilishi Road, Xicheng District, 100037, Beijing, China
| | - Zhaozhuo Niu
- Cardiac Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Chinese Academy of Medical Sciences & Fuwai Hospital, Peking Union Medical College, 167 Beilishi Road, Xicheng District, 100037, Beijing, China.
| | - Fei Li
- Department of Structural Heart Disease, Chinese Academy of Medical Sciences & Fuwai Hospital; State Key Laboratory of Cardiovascular Disease, Peking Union Medical College, 167 Beilishi Road, Xicheng District, 100037, Beijing, China. .,Department of Cardiac Surgery, Peking University First Hospital, Beijing, China.
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13
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Elsayed A, Gilbert K, Scadeng M, Cowan BR, Pushparajah K, Young AA. Four-dimensional flow cardiovascular magnetic resonance in tetralogy of Fallot: a systematic review. J Cardiovasc Magn Reson 2021; 23:59. [PMID: 34011372 PMCID: PMC8136126 DOI: 10.1186/s12968-021-00745-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Ayah Elsayed
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Miriam Scadeng
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Brett R. Cowan
- Institute of Environmental Science and Research, Auckland, New Zealand
| | | | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King’s College London, London, UK
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14
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Aortic valve surgery: management and outcomes in the paediatric population. Eur J Pediatr 2021; 180:3129-3139. [PMID: 33970315 PMCID: PMC8429384 DOI: 10.1007/s00431-021-04092-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 11/02/2022]
Abstract
Congenital anomalies of the aortic valve frequently necessitate intervention in childhood. The most common aortic valve pathologies present in childhood are aortic stenosis and insufficiency. Presentation of aortic valve disease depends on severity and presence of concomitant syndromes and valvular disorders. Treatment options are largely categorised as medical, percutaneous repair or surgical repair and replacement. Surgical techniques have been refined over the last few years making this the mainstay of treatment in paediatric cases. Whilst repair is considered in most instances before replacement, there are substantial limitations which are reflected in the frequency of reintervention and restenosis rate. Replacements are typically undertaken with tissue or mechanical prosthesis. The current gold-standard aortic valve replacement surgery is called the Ross procedure-where replacement is undertaken with a competent pulmonic valve and a simultaneous pulmonary homograft.Conclusion: In this review, we aim to outline the various surgical options and discuss efficacy and complications of various interventions. What is Known: • Congenital aortic valve defects repair options medically and surgically What is New: • Comparisons between surgical options for aortic valve repair including efficacy, risks and long-term outcomes.
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15
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Geiger J, Callaghan FM, Burkhardt BEU, Valsangiacomo Buechel ER, Kellenberger CJ. Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: application in neonates and young children. Pediatr Radiol 2021; 51:1503-1517. [PMID: 33313980 PMCID: PMC8266722 DOI: 10.1007/s00247-020-04885-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/08/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Cardiovascular MRI has become an essential imaging modality in children with congenital heart disease (CHD) in the last 15-20 years. With use of appropriate sequences, it provides important information on cardiovascular anatomy, blood flow and function for initial diagnosis and post-surgical or -interventional monitoring in children. Although considered as more sophisticated and challenging than CT, in particular in neonates and infants, MRI is able to provide information on intra- and extracardiac haemodynamics, in contrast to CT. In recent years, four-dimensional (4-D) flow MRI has emerged as an additional MR technique for retrospective assessment and visualisation of blood flow within the heart and any vessel of interest within the acquired three-dimensional (3-D) volume. Its application in young children requires special adaptations for the smaller vessel size and faster heart rate compared to adolescents or adults. In this article, we provide an overview of 4-D flow MRI in various types of complex CHD in neonates and infants to demonstrate its potential indications and beneficial application for optimised individual cardiovascular assessment. We focus on its application in clinical routine cardiovascular workup and, in addition, show some examples with pathologies other than CHD to highlight that 4-D flow MRI yields new insights in disease understanding and therapy planning. We shortly review the essentials of 4-D flow data acquisition, pre- and post-processing techniques in neonates, infants and young children. Finally, we conclude with some details on accuracy, limitations and pitfalls of the technique.
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Affiliation(s)
- Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Steinwiesstr 75, 8032, Zürich, Switzerland. .,Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland.
| | - Fraser M. Callaghan
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Center for MR research, University Children’s Hospital Zürich, Zürich, Switzerland
| | - Barbara E. U. Burkhardt
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Department of Pediatric Cardiology, University Hospital Zürich, Zürich, Switzerland
| | - Emanuela R. Valsangiacomo Buechel
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Department of Pediatric Cardiology, University Hospital Zürich, Zürich, Switzerland
| | - Christian J. Kellenberger
- Department of Diagnostic Imaging, University Children’s Hospital Zürich, Steinwiesstr 75, 8032 Zürich, Switzerland ,Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland
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16
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Pathrose A, Ma L, Berhane H, Scott MB, Chow K, Forman C, Jin N, Serhal A, Avery R, Carr J, Markl M. Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease. Magn Reson Med 2020; 85:2174-2187. [PMID: 33107141 DOI: 10.1002/mrm.28561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To systematically assess the feasibility and performance of a highly accelerated compressed sensing (CS) 4D flow MRI framework at three different acceleration factors (R) for the quantification of aortic flow dynamics and wall shear stress (WSS) in patients with aortic disease. METHODS Twenty patients with aortic disease (58 ± 15 y old; 19 M) underwent four 4D flow scans: one conventional (GRAPPA, R = 2) and three CS 4D flows with R = 5.7, 7.7, and 10.2. All scans were acquired with otherwise equivalent imaging parameters on a 1.5T scanner. Peak-systolic velocity (Vmax ), peak flow (Qmax ), and net flow (Qnet ) were quantified at the ascending aorta (AAo), arch, and descending aorta (DAo). WSS was calculated at six regions within the AAo and arch. RESULTS Mean scan times for the conventional and CS 4D flows with R = 5.7, 7.7, and 10.2 were 9:58 ± 2:58 min, 3:40 ± 1:19 min, 2:50 ± 0:56 min, and 2:05 ± 0:42 min, respectively. Vmax , Qmax , and Qnet were significantly underestimated by all CS protocols (underestimation ≤ -7%, -9%, and -10% by CS, R = 5.7, 7.7, and 10.2, respectively). WSS measurements showed the highest underestimation by all CS protocols (underestimation ≤ -9%, -12%, and -14% by CS, R = 5.7, 7.7, and 10.2). CONCLUSIONS Highly accelerated aortic CS 4D flow at R = 5.7, 7.7, and 10.2 showed moderate agreement with the conventional 4D flow, despite systematically underestimating various hemodynamic parameters. The shortened scan time may enable the clinical translation of CS 4D flow, although potential hemodynamic underestimation should be considered when interpreting the results.
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Affiliation(s)
- Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Liliana Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Haben Berhane
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Kelvin Chow
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | | | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Ali Serhal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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17
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Roberts TA, van Amerom JFP, Uus A, Lloyd DFA, van Poppel MPM, Price AN, Tournier JD, Mohanadass CA, Jackson LH, Malik SJ, Pushparajah K, Rutherford MA, Razavi R, Deprez M, Hajnal JV. Fetal whole heart blood flow imaging using 4D cine MRI. Nat Commun 2020; 11:4992. [PMID: 33020487 PMCID: PMC7536221 DOI: 10.1038/s41467-020-18790-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/10/2020] [Indexed: 12/26/2022] Open
Abstract
Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in utero approaches are compromised by spontaneous fetal motion. Here, we present and validate a novel method of MRI velocity-encoding combined with a motion-robust reconstruction framework for four-dimensional visualization and quantification of blood flow in the human fetal heart and major vessels. We demonstrate simultaneous 4D visualization of the anatomy and circulation, which we use to quantify flow rates through various major vessels. The framework introduced here could enable new clinical opportunities for assessment of the fetal cardiovascular system in both health and disease.
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Affiliation(s)
- Thomas A Roberts
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK.
| | - Joshua F P van Amerom
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Alena Uus
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - David F A Lloyd
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Milou P M van Poppel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Anthony N Price
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Jacques-Donald Tournier
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Chloe A Mohanadass
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Laurence H Jackson
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Shaihan J Malik
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Kuberan Pushparajah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Mary A Rutherford
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Centre for the Developing Brain, King's College London, London, SE1 7EH, UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, SE1 7EH, UK
| | - Maria Deprez
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
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18
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Woldendorp K, Bannon PG, Grieve SM. Evaluation of aortic stenosis using cardiovascular magnetic resonance: a systematic review & meta-analysis. J Cardiovasc Magn Reson 2020; 22:45. [PMID: 32536342 PMCID: PMC7294634 DOI: 10.1186/s12968-020-00633-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 05/08/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As the average age of patients with severe aortic stenosis (AS) who receive procedural intervention continue to age, the need for non-invasive modalities that provide accurate diagnosis and operative planning is increasingly important. Advances in cardiovascular magnetic resonance (CMR) over the past two decades mean it is able to provide haemodynamic data at the aortic valve, along with high fidelity anatomical imaging. METHODS Electronic databases were searched for studies comparing CMR to transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) in the diagnosis of AS. Studies were included only if direct comparison was made on matched patients, and if diagnosis was primarily through measurement of aortic valve area (AVA). RESULTS Twenty-three relevant, prospective articles were included in the meta-analysis, totalling 1040 individual patients. There was no significant difference in AVA measured as by CMR compared to TEE. CMR measurements of AVA size were larger compared to TTE by an average of 10.7% (absolute difference: + 0.14cm2, 95% CI 0.07-0.21, p < 0.001). Reliability was high for both inter- and intra-observer measurements (0.03cm2 +/- 0.04 and 0.02cm2 +/- 0.01, respectively). CONCLUSIONS Our analysis demonstrates the equivalence of AVA measurements using CMR compared to those obtained using TEE. CMR demonstrated a small but significantly larger AVA than TTE. However, this can be attributed to known errors in derivation of left ventricular outflow tract size as measured by TTE. By offering additional anatomical assessment, CMR is warranted as a primary tool in the assessment and workup of patients with severe AS who are candidates for surgical or transcatheter intervention.
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Affiliation(s)
- Kei Woldendorp
- Sydney Translational Imaging Laboratory, Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia
- Baird Institute of Applied Heart & Lung Surgical Research, Newtown, NSW 2042 Australia
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2006 Australia
| | - Paul G. Bannon
- Sydney Translational Imaging Laboratory, Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia
- Baird Institute of Applied Heart & Lung Surgical Research, Newtown, NSW 2042 Australia
| | - Stuart M. Grieve
- Sydney Translational Imaging Laboratory, Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006 Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW 2050 Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2006 Australia
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19
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Urmeneta Ulloa J, Álvarez Vázquez A, Martínez de Vega V, Cabrera JÁ. Evaluation of Cardiac Shunts With
4D
Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability. J Magn Reson Imaging 2020; 52:1055-1063. [DOI: 10.1002/jmri.27158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Javier Urmeneta Ulloa
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Ana Álvarez Vázquez
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Vicente Martínez de Vega
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - José Ángel Cabrera
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
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Christopher A, Olivieri L, Cross R, Ramakrishnan K, Loke YH. 4-Dimensional Flow by Cardiac Magnetic Resonance Informs Surgical Planning in Partial Anomalous Pulmonary Venous Return. JACC Case Rep 2020; 2:672-677. [PMID: 34317320 PMCID: PMC8298784 DOI: 10.1016/j.jaccas.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/08/2020] [Accepted: 02/13/2020] [Indexed: 11/16/2022]
Abstract
Four-dimensional flow cardiac magnetic resonance enhances the visualization of blood flow in a 3-dimensional volume throughout the cardiac cycle, thus dramatically improving visualization of pulmonary venous anatomy by cardiac magnetic resonance. We demonstrate the impact of 4-dimensional flow on diagnosis and surgical planning for partial anomalous pulmonary venous return. (Level of Difficulty: Beginner.).
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Key Words
- CMR, cardiac magnetic resonance
- D-TGA, D-transposition of the great arteries
- FOV, field of view
- LUPV, left upper pulmonary vein
- MRA, magnetic resonance angiography
- PAPVR, partial anomalous pulmonary venous return
- PAT, parallel acquisition technique
- RMPV, right middle pulmonary vein
- RSVC, right superior vena cava
- RUPV, right upper pulmonary vein
- SVD, sinus venosus defect
- TE, echo time
- TR, repetition time
- TTE, transthoracic echocardiogram
- VENC, velocity encoding
- cardiac magnetic resonance
- congenital heart defect
- imaging
- pediatric surgery
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Affiliation(s)
- Adam Christopher
- Division of Cardiology, Children's National Health System, Washington, DC
| | - Laura Olivieri
- Division of Cardiology, Children's National Health System, Washington, DC
| | - Russell Cross
- Division of Cardiology, Children's National Health System, Washington, DC
| | - Karthik Ramakrishnan
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Health System, Washington, DC
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Callaghan FM, Burkhardt B, Geiger J, Valsangiacomo Buechel ER, Kellenberger CJ. Flow quantification dependency on background phase correction techniques in 4D‐flow MRI. Magn Reson Med 2019; 83:2264-2275. [DOI: 10.1002/mrm.28085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/09/2019] [Accepted: 10/24/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Fraser M. Callaghan
- Center for MR Research University Children's Hospital Zurich Switzerland
- Children's Research Center University Children's Hospital Zurich Switzerland
| | - Barbara Burkhardt
- Children's Research Center University Children's Hospital Zurich Switzerland
- Division of Pediatric Cardiology University Children's Hospital Zurich Switzerland
| | - Julia Geiger
- Children's Research Center University Children's Hospital Zurich Switzerland
- Department of Diagnostic Imaging University Children's Hospital Zurich Switzerland
| | - Emanuela R. Valsangiacomo Buechel
- Children's Research Center University Children's Hospital Zurich Switzerland
- Division of Pediatric Cardiology University Children's Hospital Zurich Switzerland
| | - Christian J. Kellenberger
- Children's Research Center University Children's Hospital Zurich Switzerland
- Department of Diagnostic Imaging University Children's Hospital Zurich Switzerland
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Arafati A, Hu P, Finn JP, Rickers C, Cheng AL, Jafarkhani H, Kheradvar A. Artificial intelligence in pediatric and adult congenital cardiac MRI: an unmet clinical need. Cardiovasc Diagn Ther 2019; 9:S310-S325. [PMID: 31737539 PMCID: PMC6837938 DOI: 10.21037/cdt.2019.06.09] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/03/2019] [Indexed: 01/09/2023]
Abstract
Cardiac MRI (CMR) allows non-invasive, non-ionizing assessment of cardiac function and anatomy in patients with congenital heart disease (CHD). The utility of CMR as a non-invasive imaging tool for evaluation of CHD have been growing exponentially over the past decade. The algorithms based on artificial intelligence (AI), and in particular, deep learning, have rapidly become a methodology of choice for analyzing CMR. A wide range of applications for AI have been developed to tackle challenges in various aspects of CMR, and significant advances have also been made from image acquisition to image analysis and diagnosis. We include an overview of AI definitions, different architectures, and details on well-known methods. This paper reviews the major deep learning concepts used for analyses of patients with CHD. In the end, we have summarized a list of open challenges and concerns to be considered for future studies.
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Affiliation(s)
- Arghavan Arafati
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, CA, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - J. Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carsten Rickers
- University Heart Center, Adult with Congenital Heart Disease Unit, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Andrew L. Cheng
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Pediatric Cardiology, Children’s Hospital, Los Angeles, CA, USA
| | - Hamid Jafarkhani
- Center for Pervasive Communications and Computing, University of California, Irvine, CA, USA
| | - Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, CA, USA
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23
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Rahman O, Markl M, Balte P, Berhane H, Blanken C, Suwa K, Dashnaw S, Wieben O, Bluemke DA, Prince MR, Lima J, Michos E, Ambale-Venkatesh B, Hoffman EA, Gomes AS, Watson K, Sun Y, Carr J, Barr RG. Reproducibility and Changes in Vena Caval Blood Flow by Using 4D Flow MRI in Pulmonary Emphysema and Chronic Obstructive Pulmonary Disease (COPD): The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Substudy. Radiology 2019; 292:585-594. [PMID: 31335282 PMCID: PMC6736177 DOI: 10.1148/radiol.2019182143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 11/11/2022]
Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is associated with hemodynamic changes in the pulmonary vasculature. However, cardiac effects are not fully understood and vary by phenotype of chronic lower respiratory disease.PurposeTo use four-dimensional (4D) flow MRI for comprehensive assessment of the right-sided cardiovascular system, assess its interrater and intraobserver reproducibility, and examine associations with venous return to the right heart in individuals with chronic COPD and emphysema.Materials and MethodsThe Multi-Ethnic Study of Atherosclerosis COPD substudy prospectively recruited participants who smoked and who had COPD and nested control participants from population-based samples. Electrocardiography and respiratory gated 4D flow 1.5-T MRI was performed at three sites with full volumetric coverage of the thoracic vessels in 2014-2017 with postbronchodilator spirometry and inspiratory chest CT to quantify percent emphysema. Net flow, peak velocity, retrograde flow, and retrograde fraction were measured on 14 analysis planes. Interrater reproducibility was assessed by two independent observers, and the principle of conservation of mass was employed to evaluate the internal consistency of flow measures. Partial correlation coefficients were adjusted for age, sex, race/ethnicity, height, weight, and smoking status.ResultsAmong 70 participants (29 participants with COPD [mean age, 73.5 years ± 8.1 {standard deviation}; 20 men] and 41 control participants [mean age, 71.0 years ± 6.1; 22 men]), the interrater reproducibility of the 4D flow MRI measures was good to excellent (intraclass correlation coefficient range, 0.73-0.98), as was the internal consistency. There were no statistically significant differences in venous flow parameters according to COPD severity (P > .05). Greater percent emphysema at CT was associated with greater regurgitant flow in the superior and inferior caval veins and tricuspid valve (adjusted r = 0.28-0.55; all P < .01), particularly in the superior vena cava.ConclusionFour-dimensional flow MRI had good-to-excellent observer variability and flow consistency. Percent emphysema at CT was associated with statistically significant differences in retrograde flow, greatest in the superior vena cava.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Choe in this issue.
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Affiliation(s)
| | | | - Pallavi Balte
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Haben Berhane
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Carmen Blanken
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Kenichiro Suwa
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Stephen Dashnaw
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Oliver Wieben
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - David A. Bluemke
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Martin R. Prince
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Joao Lima
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Erin Michos
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Bharath Ambale-Venkatesh
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Eric A. Hoffman
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Antoinette S. Gomes
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Karol Watson
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - Yanping Sun
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - James Carr
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
| | - R. Graham Barr
- From the Department of Radiology, Feinberg School of Medicine,
Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611
(O.R., M.M., H.B., C.B., K.S., J.C.); Departments of Radiology (O.R., S.D.,
M.R.P., Y.S.), Medicine (P.B., Y.S., R.G.B.), and Epidemiology (R.G.B.),
Columbia University Medical Center, New York, NY; Department of Radiology,
NewYork–Presbyterian Hospital, New York, NY (O.R.); Department of
Biomedical Engineering, McCormick School of Engineering, Northwestern
University, Evanston, Ill (M.M.); Departments of Medical Physics (O.W.) and
Radiology (D.A.B.), University of Wisconsin School of Medicine and Public
Health, Madison, Wis; Division of Cardiology, Johns Hopkins University,
Baltimore, Md (J.L., E.M., B.A.V.); Department of Radiology, Biomedical
Engineering and Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); and
Departments of Radiology (A.S.G.) and Medicine (K.W.), University of California
Los Angeles, Los Angeles, Calif
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24
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Zhong L, Schrauben EM, Garcia J, Uribe S, Grieve SM, Elbaz MSM, Barker AJ, Geiger J, Nordmeyer S, Marsden A, Carlsson M, Tan RS, Garg P, Westenberg JJM, Markl M, Ebbers T. Intracardiac 4D Flow MRI in Congenital Heart Disease: Recommendations on Behalf of the ISMRM Flow & Motion Study Group. J Magn Reson Imaging 2019; 50:677-681. [PMID: 31317587 DOI: 10.1002/jmri.26858] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/08/2022] Open
Abstract
LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:677-681.
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Affiliation(s)
- Liang Zhong
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | - Eric M Schrauben
- Translational Medicine, Hospital for Sick Children, Toronto, Canada
| | - Julio Garcia
- Departments of Radiology and Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Sergio Uribe
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Radiology Department and Biomedical Imaging Center, School of Medicine, Pontifica Universidad Catolica de Chile, Chile
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia; Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Mohammed S M Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology and Bioengineering, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland
| | - Sarah Nordmeyer
- Department of Pediatric Cardiology and Congenital Heart Diseases German Heart Center Berlin Germany; Institute for Cardiovascular Computer-assisted Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - Alison Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California, USA
| | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | | | | | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tino Ebbers
- Department of Medical and Health Sciences and Center for Medical Imaging Sciences and Visualization, Linköping University, Sweden
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Hansen KL, Juul K, Møller-Sørensen H, Nilsson JC, Jensen JA, Nielsen MB. Pediatric Transthoracic Cardiac Vector Flow Imaging - A Preliminary Pictorial Study. Ultrasound Int Open 2019; 5:E20-E26. [PMID: 30599042 PMCID: PMC6303157 DOI: 10.1055/a-0656-5430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/15/2018] [Accepted: 07/01/2018] [Indexed: 01/06/2023] Open
Abstract
Purpose
Conventional pediatric echocardiography is crucial for diagnosing congenital heart disease (CHD), but the technique is impaired by angle dependency. Vector flow imaging (VFI) is an angle-independent noninvasive ultrasound alternative for blood flow assessment and can assess complex flow patterns not visible on conventional Doppler ultrasound.
Materials and Methods
12 healthy newborns and 3 infants with CHD were examined with transthoracic cardiac VFI using a conventional ultrasound scanner and a linear array.
Results
VFI examinations revealed common cardiac flow patterns among the healthy newborns, and flow changes among the infants with CHD not previously reported with conventional echocardiography.
Conclusion
For assessment of cardiac flow in the normal and diseased pediatric heart, VFI may provide additional information compared to conventional echocardiography and become a useful diagnostic tool.
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Affiliation(s)
| | - Klaus Juul
- Department of Pediatric Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hasse Møller-Sørensen
- Department of Cardiothoracic Anesthesiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens C Nilsson
- Department of Cardiothoracic Anesthesiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Technical University of Denmark, DTU Elektro, Lyngby, Denmark
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Feneis JF, Kyubwa E, Atianzar K, Cheng JY, Alley MT, Vasanawala SS, Demaria AN, Hsiao A. 4D flow MRI quantification of mitral and tricuspid regurgitation: Reproducibility and consistency relative to conventional MRI. J Magn Reson Imaging 2018; 48:1147-1158. [PMID: 29638024 PMCID: PMC7962150 DOI: 10.1002/jmri.26040] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/20/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In patients with mitral or tricuspid valve regurgitation, evaluation of regurgitant severity is essential for determining the need for surgery. While transthoracic echocardiography is widely accessible, it has limited reproducibility for grading inlet valve regurgitation. Multiplanar cardiac MRI is the quantitative standard but requires specialized local expertise, and is thus not widely available. Volumetric 4D flow MRI has potential for quantitatively grading the severity of inlet valve regurgitation in adult patients. PURPOSE To evaluate the accuracy and reproducibility of volumetric 4D flow MRI for quantification of inlet valvular regurgitation compared to conventional multiplanar MRI, which may simplify and improve accessibility of cardiac MRI. STUDY TYPE This retrospective, HIPAA-compliant imaging-based comparison study was conducted at a single institution. SUBJECTS Twenty-one patients who underwent concurrent multiplanar and 4D flow cardiac MRI between April 2015 and January 2017. FIELD STRENGTH/SEQUENCES 3T; steady-state free-precession (SSFP), 2D phase contrast (2D-PC), and postcontrast 4D flow. ASSESSMENT We evaluated the intertechnique (4D flow vs. 2D-PC), intermethod (direct vs. indirect measurement), interobserver and intraobserver reproducibility of measurements of regurgitant flow volume (RFV), fraction (RF), and volume (RVol). STATISTICAL TESTS Statistical analysis included Pearson correlation, Bland-Altman statistics, and intraclass correlation coefficients. RESULTS There was high concordance between 4D flow and multiplanar MRI, whether using direct or indirect methods of quantifying regurgitation (r = 0.813-0.985). Direct interrogation of the regurgitant jet with 4D flow showed high intraobserver consistency (r = 0.976-0.999) and interobserver consistency (r = 0.861-0.992), and correlated well with traditional indirect measurements obtained as the difference between stroke volume and forward outlet valve flow. DATA CONCLUSION 4D flow MRI provides highly reproducible measurements of mitral and tricuspid regurgitant volume, and may be used in place of conventional multiplanar MRI. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1147-1158.
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Affiliation(s)
| | - Espoir Kyubwa
- Department of Radiology, UC San Diego, La Jolla, California, USA
| | - Kimberly Atianzar
- Department of Cardiovascular Disease, Swedish Heart and Vascular Institute, Seattle, WA
| | | | | | | | | | - Albert Hsiao
- Department of Radiology, UC San Diego, La Jolla, California, USA
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27
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Evaluation of atrial septal defects with 4D flow MRI-multilevel and inter-reader reproducibility for quantification of shunt severity. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 32:269-279. [PMID: 30171383 PMCID: PMC6424937 DOI: 10.1007/s10334-018-0702-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/10/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Abstract
Purpose With the hypothesis that 4D flow can be used in evaluation of cardiac shunts, we seek to evaluate the multilevel and interreader reproducibility of measurements of the blood flow, shunt fraction and shunt volume in patients with atrial septum defect (ASD) in practice at multiple clinical sites. Materials and methods Four-dimensional flow MRI examinations were performed at four institutions across Europe and the US. Twenty-nine patients (mean age, 43 years; 11 male) were included in the study. Flow measurements were performed at three levels (valve, main artery and periphery) in both the pulmonary and systemic circulation by two independent readers and compared against stroke volumes from 4D flow anatomic data. Further, the shunt ratio (Qp/Qs) was calculated. Additionally, shunt volume was quantified at the atrial level by tracking the atrial septum. Results Measurements of the pulmonary blood flow at multiple levels correlate well whether measuring at the valve, main pulmonary artery or branch pulmonary arteries (r = 0.885–0.886). Measurements of the systemic blood flow show excellent correlation, whether measuring at the valve, ascending aorta or sum of flow from the superior vena cava (SVC) and descending aorta (r = 0.974–0.991). Intraclass agreement between the two observers for the flow measurements varies between 0.96 and 0.99. Compared with stroke volume, pulmonic flow is underestimated with 0.26 l/min at the main pulmonary artery level, and systemic flow is overestimated with 0.16 l/min at the ascending aorta level. Direct measurements of ASD flow are feasible in 20 of 29 (69%) patients. Conclusion Blood flow and shunt quantification measured at multiple levels and performed by different readers are reproducible and consistent with 4D flow MRI. Electronic supplementary material The online version of this article (10.1007/s10334-018-0702-z) contains supplementary material, which is available to authorized users.
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van der Ven JPG, van den Bosch E, Bogers AJCC, Helbing WA. State of the art of the Fontan strategy for treatment of univentricular heart disease. F1000Res 2018; 7. [PMID: 30002816 PMCID: PMC6024235 DOI: 10.12688/f1000research.13792.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Abstract
In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival. However, the resulting Fontan physiology is associated with high morbidity. In this review, we discuss the state of the art of the Fontan strategy by assessing survival and risk factors for mortality. Complications of the Fontan circulation, such as cardiac arrhythmia, thromboembolism, and protein-losing enteropathy, are discussed. Common surgical and catheter-based interventions following Fontan completion are outlined. We describe functional status measurements such as quality of life and developmental outcomes in the contemporary Fontan patient. The current role of drug therapy in the Fontan patient is explored. Furthermore, we assess the current use and outcomes of mechanical circulatory support in the Fontan circulation and novel surgical innovations. Despite large improvements in outcomes for contemporary Fontan patients, a large burden of disease exists in this patient population. Continued efforts to improve outcomes are warranted. Several remaining challenges in the Fontan field are outlined.
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Affiliation(s)
- Jelle P G van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Ad J C C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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