Four-dimensional Flow MRI: Principles and Cardiovascular                    Applications

Azarine, Arshid; Garçon, Philippe; Stansal, A.; Canepa, Nadia; Angelopoulos, Giorgios; Silvera, S.; Sidi, Daniel; Marteau, V.; Zins, Marc

doi:10.1148/rg.2019180091

Cited by 116 publications

(97 citation statements)

References 47 publications

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“…Functional flow data can be provided by 2-D phase-contrast sequences, while newer quantitative MR techniques like 4-D flow with computational fluid dynamics are under research and in clinical use in a few institutions and require specific software analysis tools (Fig. 8 ) [ 37 – 39 ]. MR strain analysis and feature tracking are, like echocardiography, newer techniques that are garnering more attention to how diastolic and systolic function perform in the single-ventricle circulation and also in pediatric patients [ 28 , 34 ].…”

Section: Cardiovascular Complicationsmentioning

confidence: 99%

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Lange

2020

Pediatr Radiol

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The Fontan operation is performed for various cardiac lesions with single-ventricle physiology. The survival rate of Fontan patients is increasing for adolescents and young adults, with an expected 30-year survival of >80%. Medical health care providers including specialists in organ systems and pediatric radiologists need to improve their knowledge about the Fontan circulation and the various organ complications to monitor care. In this review the author explains the basic anatomical and functional features of Fontan palliation and gives an overview of the multiple long-term organ complications that might present in the pediatric population. These include decreased physical capacity, ventricular dysfunction, atrioventricular valve regurgitation and arrhythmia, as well as protein-losing enteropathy, plastic bronchitis, growth/bone composition disturbances, renal dysfunction, and the recently recognized and important liver fibrosis (Fontan-associated liver disease). Neuropsychological and behavioral deficits occur frequently. This review focuses on the key role of radiology in making the diagnosis of these complications, monitoring therapy and predicting outcomes in the pediatric age group. The author discusses how and when radiology is important in Fontan patients, as well as how new techniques enabling quantitative measures in imaging with US, MRI and CT are adapted for pediatric use, and how they contribute to urgently needed surveillance strategies. Electronic supplementary material The online version of this article (10.1007/s00247-020-04682-5) contains supplementary material, which is available to authorized users.

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Section: Cardiovascular Complicationsmentioning

confidence: 99%

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Lange

2020

Pediatr Radiol

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“…Moreover, multiple sequences must be acquired to quantify the Qs, Qp, and the jet itself. By contrast, with 4D‐flow MRI the flow can be measured using 3D phase‐contrast sequences, with a fourth dimension represented by time across the cardiac cycle . Thus, with 4D‐flow MRI a wide range of flow‐related parameters can be obtained in a single acquisition, ranging from basic measurements (eg, flow volume and peak velocity) to more advanced parameters such as the hemodynamic effect of the flow on the vessel wall and visualization of flow direction .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cardiac Shunts With 4D Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability

Ulloa

Vázquez

Vega

et al. 2020

Magnetic Resonance Imaging

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Background In the last decade, the capacity of magnetic resonance (MR) to evaluate congenital anomalies has improved substantially. To date, only a few studies have evaluated the value of 4D‐flow MRI in shunt assessments. Purpose/Hypothesis To assess the intra‐ and interobserver variability of 4D‐flow MRI in patients diagnosed with cardiac/extracardiac shunt. Secondarily, to assess the feasibility of directly measuring the shunt and to determine the prognostic correlation with the pulmonary‐to‐systemic (Qp/Qs) flow ratio. Study Type Retrospective. Population In all, 18 patients with cardiac shunt diagnosis. Field Strength/Sequence 1.5 T/4D phase‐contrast MRI. Assessment Pulmonary and systemic flows were measured at different locations to assess the internal consistency by two observers (twice by one, and once by the other). The Qp/Qs ratio was calculated. When feasible, direct flow was quantified by planimetry. Statistical Tests Spearman's rho correlation coefficient was used to assess the relationship between pulmonary/systemic flows measured at different levels and to compare the jet characteristics with prognostic data as right ventricle volume. Intra‐ and interobserver variability were determined by Bland–Altman plots and interobserver correlation. Results The most common shunt type (n = 10; 55.5%) was ostium secundum atrial septal defect (ASD). Direct visualization and quantification of shunt flow was possible in all studies. Pulmonary and systemic flows showed a strong correlation between these measures (Spearman's rho [r] of 0.872 and 0.899). The mean Qp/Qs ratio was 1.61(0.62). Mean flow rate was 2.01(1.68) l/min. The mean jet diameter was 11.88 (5.44) mm. Intraobserver (r = 0.97) and interobserver correlation (ICC = 0.95) for the Qp/Qs calculation were both excellent. Direct measurement of flow was strongly correlated (r = 0.98; ICC = 0.95). Correlation was strong between Qp/Qs and direct jet flow (r = 0.76 and 0.77), Qp/Qs and mean jet diameter (r = 0.79 and 0.94), and Qp/Qs with jet area (r = 0.77 and 0.94). Data Conclusion Measurement of the Qp/Qs ratio and direct shunt quantification using 4D‐flow MRI was feasible, and highly reproducible. Internal consistency was excellent, with low intra‐ and interobserver variability. Correlation between the Qp/Qs ratio, direct flow measurement, mean diameter, and jet area was strong. Evidence Level 3 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2020;52:1055–1063.

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“…The adjusted venc represents the highest measurable blood flow velocity. Velocities above the venc cause aliasing and velocities far below the venc lead to inaccurate measurements [13]. The venc should be set 10 % higher than maximum expected blood flow velocity [4].…”

Section: Technical Considerationsmentioning

confidence: 99%

“…4D flow MRI-derived analyses of time-resolved flow velocities and flow rates are made equivalent to 2D phase contrast flow measurements: a local acceleration of flow velocity indicates a stenosis and a reduced flow rate indicates a reduced blood supply of the downstream organ [1]. If spatial resolution suffices to visualize a reliable flow profile within the vessel lumen, helical and vortical flows, flow eccentricity, and wall shear stress (WSS) can be evaluated [13]. The evaluation of these 4D flow MRI-derived parameters is being performed using different commercially available or custom-built analysis tools.…”

Section: D Flow Mri Data Analysismentioning

confidence: 99%

Abdominal Applications of 4D Flow MRI

Riedel

Lenz

Fischer

et al. 2020

Rofo

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Background Four-dimensional flow magnetic resonance imaging (4D flow MRI) provides volumetric and time-resolved visualization and quantification of blood flow. This review presents an overview of possible applications of 4D flow MRI for non-invasive assessment of abdominal hemodynamics. Method This review is based on the authors’ experience and the current literature. A PubMed database literature research was performed in December 2019 focusing on abdominal applications of 4D flow MRI. We illustrated the review with exemplary figures and movies of clinical cases from our institution. Results and Conclusion 4D flow MRI offers the possibility of comprehensive assessment of abdominal blood flows in different vascular territories and organ systems. Results of recent studies indicate that 4D flow MRI improves understanding of altered hemodynamics in patients with abdominal disease and may be useful for monitoring therapeutic response. Future studies with larger cohorts aiming to integrate 4D flow MRI in the clinical routine setting are needed. Key Points: Citation Format

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Four-dimensional Flow MRI: Principles and Cardiovascular Applications

Cited by 116 publications

References 47 publications

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

Evaluation of Cardiac Shunts With 4D Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability

Abdominal Applications of 4D Flow MRI

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