Disturbed Intracardiac Flow Organization After Atrioventricular Septal Defect Correction as Assessed With 4D Flow Magnetic Resonance Imaging and Quantitative Particle Tracing

Calkoen, Emmeline E.; Koning, Patrick J.H. de; Blom, Nico A.; Kroft, Lucia J.M.; Roos, Albert de; Wolterbeek, Ron; Roest, Arno A.W.; Westenberg, Jos J.M.

doi:10.1097/rli.0000000000000194

Cited by 15 publications

(26 citation statements)

References 26 publications

(34 reference statements)

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“…A fifth component can be added, Regurgitation blood that leaves the LV through the mitral valve into the atrium during systole [42]. It should be taken into account that particle tracing analysis requires high temporal resolution and adequate signal-to-noise, as results coming from an integration procedure on noisy data and over large time steps may not be reliable.…”

Section: Visualization and Quantificationmentioning

confidence: 99%

“…In the normal LV, 30–35% of the LV end diastolic volume represents blood flow that enters the LV during diastole and is ejected into the aorta during systole in the subsequent heartbeat (i.e. direct flow) [39, 42]. Using 4D flow CMR, vortical flow patterns have been described that form during diastole, with a close relation to the motion of the anterior mitral leaflet and the shape of mitral inflow [43, 44, 63].…”

Section: Applicationsmentioning

confidence: 99%

“…2) [32]. 4D flow CMR with particle tracing showed that this altered inflow after AVSD correction also affected the intra-cardiac flow organization, which presented as reduced direct flow and increased retained inflow in the apical and lateral region of the LV cavity [42]. Despite that global cardiac function parameters (including ejection fraction, end diastolic volume, stroke volume and cardiac output) were within the normal range in these patients, significantly altered vortex ring flow properties were found and associated with a 2–4 fold increase in viscous energy loss levels compared to healthy volunteers [2, 45].…”

Section: Applicationsmentioning

confidence: 99%

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Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

Kamphuis

Westenberg

Palen

et al. 2016

Int J Cardiovasc Imaging

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Knowledge of normal and abnormal flow patterns in the human cardiovascular system increases our understanding of normal physiology and may help unravel the complex pathophysiological mechanisms leading to cardiovascular disease. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has emerged as a suitable technique that enables visualization of in vivo blood flow patterns and quantification of parameters that could potentially be of prognostic value in the disease process. In this review, current image processing tools that are used for comprehensive visualization and quantification of blood flow and energy distribution in the heart and great vessels will be discussed. Also, imaging biomarkers extracted from 4D flow CMR will be reviewed that have been shown to distinguish between normal and abnormal flow patterns. Furthermore, current applications of 4D flow CMR in the heart and great vessels will be discussed, showing its potential as an additional diagnostic modality which could aid in disease management and timing of surgical intervention.

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Section: Visualization and Quantificationmentioning

confidence: 99%

Section: Applicationsmentioning

confidence: 99%

Section: Applicationsmentioning

confidence: 99%

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Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

Kamphuis

Westenberg

Palen

et al. 2016

Int J Cardiovasc Imaging

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“…With the use of some of these accelerated acquisition methods free‐breathing “whole‐heart” 4D flow cardiac MR can be performed in a total scan time of 10 min or less depending on size of the heart, heart rate and patient habitus . A recently published consensus document recommends the use of 4D segmented fast spoiled gradient echo (4D‐SPGR) pulse sequences for 4D flow cardiac MR with a segmentation factor of 2 based on the experience of research institutions .…”

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confidence: 99%

Comparison of fast acquisition strategies in whole‐heart four‐dimensional flow cardiac MR: Two‐center, 1.5 Tesla, phantom and in vivo validation study

Garg

Westenberg

Boogaard

et al. 2017

Magnetic Resonance Imaging

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PurposeTo validate three widely‐used acceleration methods in four‐dimensional (4D) flow cardiac MR; segmented 4D‐spoiled‐gradient‐echo (4D‐SPGR), 4D‐echo‐planar‐imaging (4D‐EPI), and 4D‐k‐t Broad‐use Linear Acquisition Speed‐up Technique (4D‐k‐t BLAST).Materials and MethodsAcceleration methods were investigated in static/pulsatile phantoms and 25 volunteers on 1.5 Tesla MR systems. In phantoms, flow was quantified by 2D phase‐contrast (PC), the three 4D flow methods and the time‐beaker flow measurements. The later was used as the reference method. Peak velocity and flow assessment was done by means of all sequences. For peak velocity assessment 2D PC was used as the reference method. For flow assessment, consistency between mitral inflow and aortic outflow was investigated for all pulse‐sequences. Visual grading of image quality/artifacts was performed on a four‐point‐scale (0 = no artifacts; 3 = nonevaluable).ResultsFor the pulsatile phantom experiments, the mean error for 2D PC = 1.0 ± 1.1%, 4D‐SPGR = 4.9 ± 1.3%, 4D‐EPI = 7.6 ± 1.3% and 4D‐k‐t BLAST = 4.4 ± 1.9%. In vivo, acquisition time was shortest for 4D‐EPI (4D‐EPI = 8 ± 2 min versus 4D‐SPGR = 9 ± 3 min, P < 0.05 and 4D‐k‐t BLAST = 9 ± 3 min, P = 0.29). 4D‐EPI and 4D‐k‐t BLAST had minimal artifacts, while for 4D‐SPGR, 40% of aortic valve/mitral valve (AV/MV) assessments scored 3 (nonevaluable). Peak velocity assessment using 4D‐EPI demonstrated best correlation to 2D PC (AV:r = 0.78, P < 0.001; MV:r = 0.71, P < 0.001). Coefficient of variability (CV) for net forward flow (NFF) volume was least for 4D‐EPI (7%) (2D PC:11%, 4D‐SPGR: 29%, 4D‐k‐t BLAST: 30%, respectively).ConclusionIn phantom, all 4D flow techniques demonstrated mean error of less than 8%. 4D‐EPI demonstrated the least susceptibility to artifacts, good image quality, modest agreement with the current reference standard for peak intra‐cardiac velocities and the highest consistency of intra‐cardiac flow quantifications. Level of Evidence: 1 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2018;47:272–281.

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“…In such cases, a direct flow assessment at the LV inlet and outlet will resolve these limitations . 4D flow MRI (3D cine phase‐contrast [PC] magnetic resonance imaging [MRI] with three‐directional velocity‐encoding) represents all directions and spatial regions of blood flow velocity and has emerged as a suitable technique for comprehensive visualization and quantification of blood flow volumes over the valves . 4D flow MRI with retrospective valve tracking enables accurate direct flow volume quantification through all four valves within a single acquisition, even in patients with valve regurgitation and allows assessment of diastolic function in the presence of aortic or pulmonary valve regurgitation .…”

mentioning

confidence: 99%

In‐scan and scan–rescan assessment of LV in‐ and outflow volumes by 4D flow MRI versus 2D planimetry

Kamphuis

Palen

Koning

et al. 2017

Magnetic Resonance Imaging

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PurposeTo evaluate the in‐scan and scan–rescan consistency of left ventricular (LV) in‐ and outflow assessment from 1) 2D planimetry; 2) 4D flow magnetic resonance imaging (MRI) with retrospective valve tracking, and 3) 4D flow MRI with particle tracing.Materials and MethodsTen healthy volunteers (age 27 ± 3 years) underwent multislice cine short‐axis planimetry and whole‐heart 4D flow MRI on a 3T MRI scanner twice with repositioning between the scans. LV in‐ and outflow was compared from 1) 2D planimetry; 2) 4D flow MRI with retrospective valve tracking over the mitral valve (MV) and aortic valve (AV), and 3) 4D flow MRI with particle tracing through forward and backward integration of velocity data.ResultsIn‐scan consistency between MV and AV flow volumes is excellent for both 4D flow MRI methods with r ≥ 0.95 (P ≤ 0.001). In‐scan AV and MV flow by retrospective valve tracking shows good to excellent correlations versus AV and MV flow by particle tracing (r ≥ 0.81, P ≤ 0.004). Scan–rescan SV assessment by 2D planimetry shows excellent reproducibility (intraclass correlation [ICC] = 0.98, P < 0.001, coefficient of variation [CV] = 7%). Scan–rescan MV and AV flow volume assessment by retrospective valve tracking shows strong reproducibility (ICCs ≥ 0.89, P ≤ 0.05, CVs = 12%), as well as by forward and backward particle tracing (ICCs ≥ 0.90, P ≤ 0.001, CVs ≤ 11%). Multicomponent particle tracing shows good scan–rescan reproducibility (ICCs ≥ 0.81, P ≤ 0.007, CVs ≤ 16%).ConclusionLV in‐ and outflow assessment by 2D planimetry and 4D flow MRI with retrospective valve tracking and particle tracing show good in‐scan consistency and strong scan–rescan reproducibility, which indicates that both 4D flow MRI methods are reliable and can be used clinically. Level of Evidence: 2 Technical Efficacy Stage: 2J. Magn. Reson. Imaging 2018;47:511–522.

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Disturbed Intracardiac Flow Organization After Atrioventricular Septal Defect Correction as Assessed With 4D Flow Magnetic Resonance Imaging and Quantitative Particle Tracing

Cited by 15 publications

References 26 publications

Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

Comparison of fast acquisition strategies in whole‐heart four‐dimensional flow cardiac MR: Two‐center, 1.5 Tesla, phantom and in vivo validation study

In‐scan and scan–rescan assessment of LV in‐ and outflow volumes by 4D flow MRI versus 2D planimetry

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