Caval Blood Flow Distribution in Patients with Fontan Circulation: Quantification by Using Particle Traces from 4D Flow MR Imaging

Bächler, Pablo; Valverde, Israel; Pinochet, Natalia; Nordmeyer, Sarah; Küehne, Titus; Crelier, Gérard; Tejos, Cristián; Irarrázaval, Pablo; Beerbaum, Philipp; Uribe, Sergio

doi:10.1148/radiol.12120778

Cited by 49 publications

(54 citation statements)

References 25 publications

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“…The results in our study extend those findings demonstrating good agreement in Fontan patients between flow distribution and net flow measurements and between observers. Previous MRI studies have found IVC flow preference to the LPA and SVC flow preference to the RPA [12, 20]. Similarly, we found more patients with IVC flow preference to the LPA than to the RPA and with SVC flow preference to the RPA than the LPA.…”

Section: Discussionsupporting

confidence: 83%

“…Previous work by Bachler et al [20] utilizing whole-heart 4-D flow MRI included a validation study in healthy controls for using time-resolved 3-D pathlines emitted from regions of interest to quantify flow distribution. The results in our study extend those findings demonstrating good agreement in Fontan patients between flow distribution and net flow measurements and between observers.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

et al. 2016

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Background Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry. Objective We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry. Materials and methods Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16±4 years [mean ± standard deviation; range 9–21 years]). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle). Results Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78%±28 [9–100], IVC to LPA: 54%±28 [4–98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R2=0.50, P=0.02; SVC to LPA: R2=0.81, P=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values. Conclusion Four-dimensional (4-D) flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

et al. 2016

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“…In complement to standard CMR protocols, time-resolved 3D phase contrast MRI (also called 4D Flow MRI) facilitates the visualization and quantification of blood flow in the cardiovascular system in order to obtain detailed information on vascular hemodynamics 10, 11 . Thus, the technique may be a promising method to evaluate altered blood flow in patients with CHD with complex anatomy and hemodynamics 12–18 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of intracardiac flow and vorticity in the right heart of patients after repair of tetralogy of Fallot by flow-sensitive 4D MRI

et al. 2016

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Objectives To comprehensively and quantitatively analyze flow and vorticity in the right heart of patients after repair of tetralogy of Fallot (rTOF) compared with healthy volunteers. Methods Time-resolved flow-sensitive 4D MRI was acquired in 24 rTOF patients and 12 volunteers. Qualitative flow evaluation was based on consensus reading of two observers. Quantitative analysis included segmentation of the right atrium (RA) and ventricle (RV) in a 4-chamber view to extract volumes and regional hemodynamic information for computation of regional mean and peak vorticity. Results Right heart intra-atrial, intraventricular and outflow tract flow patterns differed considerably between rTOF patients and volunteers. Peak RA and mean RV vorticity was significantly higher in patients (p=0.02/0.05). Significant negative correlations were found between patients’ maximum and mean RV and RA vorticity and ventricular volumes (p<0.05). The main pulmonary artery (MPA) regurgitant flow was associated with higher RA and RV vorticity, which was significant for RA maximum and RV mean vorticity (p=0.01/0.03). Conclusion The calculation of vorticity based on 4D flow data is an alternative approach to assess intracardiac flow changes in rTOF patients compared with qualitative flow visualization. Alterations in intracardiac vorticity could be relevant with regard to the development of RV dilation and impaired function.

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“…20-23 Truong et al recently used 2D phase contrast of the right pulmonary artery to measure WSS in children with pulmonary artery hypertension. 24 However, the impact of BAV on changes in blood flow and the association with age and aortic size is poorly understood.…”

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confidence: 99%

Thoracic aorta 3D hemodynamics in pediatric and young adult patients with bicuspid aortic valve

Allen

Ooij

Barker

et al. 2015

Magnetic Resonance Imaging

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Background To evaluate the 3D hemodynamics in the thoracic aorta of pediatric and young adult bicuspid aortic valve (BAV) patients. Methods 4D flow MRI was performed in 30 pediatric and young adult BAV patients (age: 13.9 ± 4.4 (range: [3.4, 20.7]) years old, M:F = 17:13) as part of this Institutional Review Board-approved study. Nomogram-based aortic root Z-scores were calculated to assess aortic dilatation and degree of aortic stenosis (AS) severity was assessed on MRI. Data analysis included calculation of time-averaged systolic 3D wall shear stress (WSSsys) along the entire aorta wall, and regional quantification of maximum and mean WSSsys and peak systolic velocity (velsys) in the ascending aorta (AAo), arch, and descending aorta (DAo). The 4D flow MRI AAo velsys was also compared with echocardiography peak velocity measurements. Results There was a positive correlation with both mean and max AAo WSSsys and peak AAo velsys (mean: r = 0.84, P < 0.001, max: r = 0.94, P < 0.001) and AS (mean: rS = 0.43, P = 0.02, max: rS = 0.70, P < 0.001). AAo peak velocity was significantly higher when measured with echo compared with 4D flow MRI (2.1 ± 0.98 m/s versus 1.27 ± 0.49 m/s, P < 0.001). Conclusion In pediatric and young adult patients with BAV, AS and peak ascending aorta velocity are associated with increased AAo WSS, while aortic dilation, age, and body surface area do not significantly impact AAo hemodynamics. Prospective studies are required to establish the role of WSS as a risk-stratification tool in these patients.

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Caval Blood Flow Distribution in Patients with Fontan Circulation: Quantification by Using Particle Traces from 4D Flow MR Imaging

Abstract: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120778/-/DC1.

Cited by 49 publications

References 25 publications

Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

Assessment of intracardiac flow and vorticity in the right heart of patients after repair of tetralogy of Fallot by flow-sensitive 4D MRI

Thoracic aorta 3D hemodynamics in pediatric and young adult patients with bicuspid aortic valve

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