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4-D flow magnetic resonance imaging: blood flow quantification compared to 2-D phase-contrast magnetic resonance imaging and Doppler echocardiography

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Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Doppler echocardiography (echo) is the reference standard for blood flow velocity analysis, and two-dimensional (2-D) phase-contrast magnetic resonance imaging (MRI) is considered the reference standard for quantitative blood flow assessment. However, both clinical standard-of-care techniques are limited by 2-D acquisitions and single-direction velocity encoding and may make them inadequate to assess the complex three-dimensional hemodynamics seen in congenital heart disease. Four-dimensional flow MRI (4-D flow) enables qualitative and quantitative analysis of complex blood flow in the heart and great arteries.

Objectives

The objectives of this study are to compare 4-D flow with 2-D phase-contrast MRI for quantification of aortic and pulmonary flow and to evaluate the advantage of 4-D flow-based volumetric flow analysis compared to 2-D phase-contrast MRI and echo for peak velocity assessment in children and young adults.

Materials and methods

Two-dimensional phase-contrast MRI of the aortic root, main pulmonary artery (MPA), and right and left pulmonary arteries (RPA, LPA) and 4-D flow with volumetric coverage of the aorta and pulmonary arteries were performed in 50 patients (mean age: 13.1 ± 6.4 years). Four-dimensional flow analyses included calculation of net flow and regurgitant fraction with 4-D flow analysis planes similarly positioned to 2-D planes. In addition, 4-D flow volumetric assessment of aortic root/ascending aorta and MPA peak velocities was performed and compared to 2-D phase-contrast MRI and echo.

Results

Excellent correlation and agreement were found between 2-D phase-contrast MRI and 4-D flow for net flow (r = 0.97, P < 0.001) and excellent correlation with good agreement was found for regurgitant fraction (r = 0.88, P < 0.001) in all vessels. Two-dimensional phase-contrast MRI significantly underestimated aortic (P = 0.032) and MPA (P < 0.001) peak velocities compared to echo, while volumetric 4-D flow analysis resulted in higher (aortic: P = 0.001) or similar (MPA: P = 0.98) peak velocities relative to echo.

Conclusion

Excellent flow parameter agreement between 2-D phase-contrast MRI and 4-D flow and the improved volumetric 4-D flow velocity analysis relative to echo suggests that 4-D flow has the potential to become a clinical alternative to 2-D phase-contrast MRI.

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Acknowledgments

Grant support was provided by the National Institutes of Health NHLBI R01HL115828; DFG (Deutsche Forschungsgemeinschaft/German Research Foundation) SCHN-1170/2-1 and SIR (Society of Interventional Radiology) Foundation Pilot Research Grant. The funding organizations did not participate in study design, did not participate in data collection or interpretation, did not help in manuscript writing, and did not participate in the manuscript submission decision.

The authors wish to thank Marci Messina, RT(R)(MR), for her assistance with patient scanning, and Samantha E. Schoeneman, BA, for her assistance with data collection.

Conflicts of interest

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Authors and Affiliations

  1. Department of Medical Imaging #9, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL, 60611, USA

    Maya Gabbour & Cynthia K. Rigsby

  2. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Susanne Schnell, Michael Markl & Cynthia K. Rigsby

  3. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA

    Kelly Jarvis & Michael Markl

  4. Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Joshua D. Robinson

  5. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Joshua D. Robinson

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  1. Maya Gabbour
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  2. Susanne Schnell
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  3. Kelly Jarvis
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  4. Joshua D. Robinson
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  5. Michael Markl
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Correspondence to Cynthia K. Rigsby.

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Gabbour, M., Schnell, S., Jarvis, K. et al. 4-D flow magnetic resonance imaging: blood flow quantification compared to 2-D phase-contrast magnetic resonance imaging and Doppler echocardiography. Pediatr Radiol 45, 804–813 (2015). https://doi.org/10.1007/s00247-014-3246-z

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  • DOI: https://doi.org/10.1007/s00247-014-3246-z

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