4D flow cardiac magnetic resonance in children and adults with congenital heart disease: Clinical experience in a high volume center

Isorni, Marc-Antoine; Moisson, L.; Moussa, Nidal Ben; Monnot, S.; Raimondi, Francesca; Roussin, Régine; Boët, Angèle; Aerschot, Isabelle Van; Fournier, Éric; Cohen, Sarah; Kara, Meriem Mostefa; Hascoët, Sébastien

doi:10.1016/j.ijcard.2020.07.021

Cited by 17 publications

(11 citation statements)

References 28 publications

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“…P ediatric time-resolved three-dimensional (3D) phase-contrast magnetic resonance imaging (MRI) (four-dimensional [4D] flow MRI) is a promising tool to quantify complex flow hemodynamics in the presence of congenital heart disease (CHD). [1][2][3] Four-dimensional flow MRI enables a comprehensive assessment of proximal cardiovascular function, with the flexibility to perform post-hoc hemodynamic analysis, even in the presence of abnormal CHD anatomy. [4][5][6][7] While the approach has the potential to reduce time via simplified planning, accurate 4D flow measurements are dependent on careful vessel identification and segmentation during postprocessing.…”

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confidence: 99%

“…Pediatric time‐resolved three‐dimensional (3D) phase‐contrast magnetic resonance imaging (MRI) (four‐dimensional [4D] flow MRI) is a promising tool to quantify complex flow hemodynamics in the presence of congenital heart disease (CHD) 1–3 . Four‐dimensional flow MRI enables a comprehensive assessment of proximal cardiovascular function, with the flexibility to perform post‐hoc hemodynamic analysis, even in the presence of abnormal CHD anatomy 4–7 .…”

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confidence: 99%

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Segmentation of the Aorta and Pulmonary Arteries Based on 4D Flow MRI in the Pediatric Setting Using Fully Automated Multi‐Site, Multi‐Vendor, and Multi‐Label Dense U‐Net

Fujiwara

Berhane

Scott

et al. 2021

Magnetic Resonance Imaging

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Background Automated segmentation using convolutional neural networks (CNNs) have been developed using four‐dimensional (4D) flow magnetic resonance imaging (MRI). To broaden usability for congenital heart disease (CHD), training with multi‐institution data is necessary. However, the performance impact of heterogeneous multi‐site and multi‐vendor data on CNNs is unclear. Purpose To investigate multi‐site CNN segmentation of 4D flow MRI for pediatric blood flow measurement. Study Type Retrospective. Population A total of 174 subjects across two sites (female: 46%; N = 38 healthy controls, N = 136 CHD patients). Participants from site 1 (N = 100), site 2 (N = 74), and both sites (N = 174) were divided into subgroups to conduct 10‐fold cross validation (10% for testing, 90% for training). Field Strength/Sequence 3 T/1.5 T; retrospectively gated gradient recalled echo‐based 4D flow MRI. Assessment Accuracy of the 3D CNN segmentations trained on data from single site (single‐site CNNs) and data across both sites (multi‐site CNN) were evaluated by geometrical similarity (Dice score, human segmentation as ground truth) and net flow quantification at the ascending aorta (Qs), main pulmonary artery (Qp), and their balance (Qp/Qs), between human observers, single‐site and multi‐site CNNs. Statistical Tests Kruskal–Wallis test, Wilcoxon rank‐sum test, and Bland–Altman analysis. A P‐value <0.05 was considered statistically significant. Results No difference existed between single‐site and multi‐site CNNs for geometrical similarity in the aorta by Dice score (site 1: 0.916 vs. 0.915, P = 0.55; site 2: 0.906 vs. 0.904, P = 0.69) and for the pulmonary arteries (site 1: 0.894 vs. 0.895, P = 0.64; site 2: 0.870 vs. 0.869, P = 0.96). Qs site‐1 medians were 51.0–51.3 mL/cycle (P = 0.81) and site‐2 medians were 66.7–69.4 mL/cycle (P = 0.84). Qp site‐1 medians were 46.8–48.0 mL/cycle (P = 0.97) and site‐2 medians were 76.0–77.4 mL/cycle (P = 0.98). Qp/Qs site‐1 medians were 0.87–0.88 (P = 0.97) and site‐2 medians were 1.01–1.03 (P = 0.43). Bland–Altman analysis for flow quantification found equivalent performance. Data Conclusion Multi‐site CNN‐based segmentation and blood flow measurement are feasible for pediatric 4D flow MRI and maintain performance of single‐site CNNs. Level of Evidence 3 Technical Efficacy Stage 2

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confidence: 99%

Segmentation of the Aorta and Pulmonary Arteries Based on 4D Flow MRI in the Pediatric Setting Using Fully Automated Multi‐Site, Multi‐Vendor, and Multi‐Label Dense U‐Net

Fujiwara

Berhane

Scott

et al. 2021

Magnetic Resonance Imaging

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“…Although traditional 3DE can display some congenital malformations, there remain shortcomings in the resolution of small structures and the display of deeper organizational structures (Ge, 2010;Khoshhal, 2013;Charakida et al, 2014;Cossor et al, 2015). Therefore, the preoperative evaluation and Frontiers in Physiology frontiersin.org intraoperative guidance of CHD may require other relatively expensive and time-consuming imaging techniques (Silvestry et al, 2014;Jone et al, 2016;Isorni et al, 2020). The novel TrueVue, TrueVue Light, and TrueVue Glass series of 3DE overcome these deficiencies to some extent, providing more detailed and accurate information for CHD both in the preoperative diagnosis and postoperative follow-up.…”

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confidence: 99%

Novel TrueVue series of 3D echocardiography: Revealing the pathological morphology of congenital heart disease

Sun

Chen

et al. 2022

Front. Physiol.

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Aims: This study explored the advantages and limitations of novel series of three-dimensional (3D) echocardiographic techniques and summarized their application methods for congenital heart diseases (CHDs).Method and result: Two-dimensional (2D), traditional 3D echocardiography, and TrueVue plus light and/or Glass novel 3D technologies were performed on 62 patients with CHD, and a clinical survey was designed to judge whether the novel 3D images were more helpful for understanding the cardiac condition and guide treatment than traditional 3D images. TrueVue increased the visual resolution and simulated the true texture of cardiac tissue, significantly improving the display ability of abnormal anatomical structures in CHDs. TrueVue Glass displayed the blood channel and the internal structure of cardiac cavity more intuitively, indicating a new observation aspect not shown by conventional echocardiography. The clinical survey results showed that the new 3D imaging methods effectively increased the diagnostic confidence of echocardiographers, enabled surgeons to better understand the details of lesions, promoted efficient communication, and improved the confidence of both doctors and patients in treatment.Conclusion: The combined application of TrueVue, TrueVue Light, and TrueVue Glass more closely simulated real anatomical features, showed more comprehensive and subtle blood flow in the lumen, not only increased the visual effect but also provided more useful diagnostic information, improved the accuracy of evaluation and treatment of CHD when compared to traditional imaging techniques, indicating that this combined application has significant clinical value.

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“…Most recently, four-dimensional (4D) flow MRI has emerged as a promising technique to gain hemodynamic insights in patients with a Fontan circuit (10,11). Recent studies have begun to show that 4D flow may be more reliable than conventional phase-contrast MRI for the quantification of blood flow volume (12)(13)(14)(15) and ability to quantify inlet valvular regurgitation (16,17). Additionally, there is a closer relationship to shunt fraction measurements from 4D flow MRI compared with those obtained during cardiac catheterization (18).…”

Section: Patient Samplementioning

confidence: 99%

Prevalence of Venovenous Shunting and High-Output State Quantified with 4D Flow MRI in Patients with Fontan Circulation

Raimondi¹,

Martins²,

Coenen³

et al. 2021

Radiology: Cardiothoracic Imaging

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ost-Fontan procedure single-ventricle physiology is among the most complex congenital heart diseases to manage, as it is associated with high morbidity and mortality (1). The Fontan procedure was originally conceived in 1971 for palliation of tricuspid atresia (2); since then, the procedure has undergone several technical revisions and is now a common endpoint for single-ventricle pathologic conditions. While the majority (.90%) of patients with Fontan circulation now survive to adult age (3), the Fontan palliation has several known long-term complications, including ventricular failure, hepatic cirrhosis, and lymphatic complications such as protein-losing enteropathy and plastic bronchitis. Thromboembolism and thrombosis of the Fontan circuit can also contribute to Fontan failure. Therefore, attentive surveillance during follow-up is crucial for the clinical management of patients who have undergone the Fontan procedure (4).Noninvasive cardiac imaging provides essential information about the anatomic and physiologic status of the Fontan circulation, which has been used to better manage and mitigate potential complications (5). Traditionally, this has included evaluation of atrial septal anatomy, ventricular function, atrioventricular and systemic valve function, anatomy of Fontan conduit, collateral flow, aortic arch anatomy, fenestration flow, and myocardial fibrosis (6,7). Echocardiography remains a first-line modality for initial evaluation, capable of evaluating multiple aspects of the Fontan circuit and ventricle (8). However, several aspects of the complex anatomy of the Fontan circuit are obscured from echocardiographic interrogation and benefit from MRI This copy is for personal use only. To order printed copies, contact

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4D flow cardiac magnetic resonance in children and adults with congenital heart disease: Clinical experience in a high volume center

Cited by 17 publications

References 28 publications

Segmentation of the Aorta and Pulmonary Arteries Based on 4D Flow MRI in the Pediatric Setting Using Fully Automated Multi‐Site, Multi‐Vendor, and Multi‐Label Dense U‐Net

Segmentation of the Aorta and Pulmonary Arteries Based on 4D Flow MRI in the Pediatric Setting Using Fully Automated Multi‐Site, Multi‐Vendor, and Multi‐Label Dense U‐Net

Novel TrueVue series of 3D echocardiography: Revealing the pathological morphology of congenital heart disease

Prevalence of Venovenous Shunting and High-Output State Quantified with 4D Flow MRI in Patients with Fontan Circulation

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