Reduced scan time and superior image quality with 3D flow MRI compared to 4D flow MRI for hemodynamic evaluation of the Fontan pathway

AbstractLong scan times prohibit a widespread clinical applicability of 4D flow MRI in Fontan patients. As pulsatility in the Fontan pathway is minimal during the cardiac cycle, acquiring non-ECG gated 3D flow MRI may result in a reduction of scan time while accurately obtaining time-averaged clinical parameters in comparison with 2D and 4D flow MRI. Thirty-two Fontan patients prospectively underwent 2D (reference), 3D and 4D flow MRI of the Fontan pathway. Multiple clinical parameters were assessed from time-averaged flow rates, including the right-to-left pulmonary flow distribution (main endpoint) and systemic-to-pulmonary collateral flow (SPCF). A ten-fold reduction in scan time was achieved [4D flow 15.9 min (SD 2.7 min) and 3D flow 1.6 min (SD 7.8 s), p < 0.001] with a superior signal-to-noise ratio [mean ratio of SNRs 1.7 (0.8), p < 0.001] and vessel sharpness [mean ratio 1.2 (0.4), p = 0.01] with 3D flow. Compared to 2D flow, good–excellent agreement was shown for mean flow rates (ICC 0.82–0.96) and right-to-left pulmonary flow distribution (ICC 0.97). SPCF derived from 3D flow showed good agreement with that from 4D flow (ICC 0.86). 3D flow MRI allows for obtaining time-averaged flow rates and derived clinical parameters in the Fontan pathway with good–excellent agreement with 2D and 4D flow, but with a tenfold reduction in scan time and significantly improved image quality compared to 4D flow.

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Caval to pulmonary 3D flow distribution in patients with Fontan circulation and impact of potential 4D flow MRI error sources

Magnetic Resonance in Medicine ◽

10.1002/mrm.27455 ◽

2018 ◽

Vol 81 (2) ◽

pp. 1205-1218 ◽

Cited By ~ 2

Author(s):

Kelly Jarvis ◽

Susanne Schnell ◽

Alex J. Barker ◽

Michael Rose ◽

Joshua D. Robinson ◽

...

Keyword(s):

Flow Distribution ◽

Fontan Circulation ◽

4D Flow Mri ◽

3D Flow ◽

4D Flow ◽

Error Sources ◽

Flow Mri

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Abstract 14367: Abnormal Pulmonary Flow is Associated With Impaired Right Ventricular Coupling in Patients With COPD

Circulation ◽

10.1161/circ.142.suppl_3.14367 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ani Oganesyan ◽

Alex J Barker ◽

Benjamin S Frank ◽

Dunbar D IVY ◽

Lorna Browne ◽

...

Keyword(s):

Strong Association ◽

Pulmonary Arteries ◽

Healthy Controls ◽

4D Flow Mri ◽

4D Flow ◽

Pulmonary Flow ◽

Copd Patients ◽

Flow Mri ◽

Pulmonary Arterial ◽

Rv Function

Introduction: Cor Pulmonale or right ventricular (RV) dysfunction due to pulmonary disease is an expected complication of COPD resulting from increased afterload mediated by hypoxic pulmonary vasoconstriction as well as the destruction of the pulmonary vascular bed. Early detection of elevated RV afterload has been previously demonstrated by visualization of abnormal flow patterns in the proximal pulmonary arteries. Prior quantitative analysis of helicity in the pulmonary arteries of pulmonary hypertension patients has demonstrated a strong association between helicity and increased RV afterload. Hypothesis: Patients with COPD will have abnormal pulmonary flow as evaluated by 4D-Flow MRI and associated with RV function and pulmonary arterial stiffness. Methods: Patients with COPD (n=15) (65yrs ± 6) and controls (n=10) (58yrs ± 9) underwent 4D-Flow MRI to calculate helicity (Figure 1A). The helicity was calculated in 2 segments: 1) the main pulmonary artery (MPA) and 2) along the RV outflow tract (RVOT) - MPA axis. Main pulmonary arterial stiffness was measured using the relative area change (RAC). Results: COPD patients had decreased helicity relative to healthy controls in the MPA (19.4±7.8 vs 32.8±15.9 s -2 , P=0.007) (Figure 1B). Additionally, COPD patients had reduced helicity along the RVOT-MPA axis (33.2±9.0 vs 43.5±8.3 s -2 , P=0.010). The helicity measured in the MPA was associated with RV end-systolic volume (R=0.59, P = 0.002), RVEF (R=0.631, P<0.001), RAC (R=-0.61, P=0.001). e combined helicity along the MPA-RVOT axis was associated with RVEF (R=0.74, P<0.001), RVESV (R=-0.57, P=0.004), and RAC (R=0.42, P=0.005). Conclusion: Patients with COPD show quantitatively abnormal flow hemodynamics, when compared with healthy controls, as assessed by 4D-Flow MRI. A strong association between helicity along the MPA-RV outflow tract axis and RV function suggests that 4D-Flow MRI might be a sensitive tool in evaluating RV - pulmonary arterial coupling in COPD.

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Abstract TMP108: Evaluation of Cerebral Arteriovenous Malformations using Flow Distribution Network Graphs and Dual-VENC 4D Flow MRI

Stroke ◽

10.1161/str.50.suppl_1.tmp108 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Maria Aristova ◽

Alireza Vali ◽

Sameer Ansari ◽

Ali Shaibani ◽

Babak Jahromi ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Distribution Network ◽

Flow Distribution ◽

Cerebral Arteriovenous Malformations ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri

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Usefulness of 4D-Flow MRI in Mapping Flow Distribution Through Failing Fontan Circulation Prior to Cardiac Intervention

Pediatric Cardiology ◽

10.1007/s00246-019-02101-7 ◽

2019 ◽

Vol 40 (5) ◽

pp. 1093-1096 ◽

Cited By ~ 2

Author(s):

Daniel McLennan ◽

Michal Schäfer ◽

Max B. Mitchell ◽

Gareth J. Morgan ◽

Dunbar Ivy ◽

...

Keyword(s):

Flow Distribution ◽

Fontan Circulation ◽

4D Flow Mri ◽

4D Flow ◽

Cardiac Intervention ◽

Flow Mri ◽

Failing Fontan

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Disproportionate intraventricular viscous energy loss in Fontan patients: analysis by 4D flow MRI

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jey096 ◽

2018 ◽

Vol 20 (3) ◽

pp. 323-333 ◽

Cited By ~ 13

Author(s):

Vivian P Kamphuis ◽

Mohammed S M Elbaz ◽

Pieter J van den Boogaard ◽

Lucia J M Kroft ◽

Rob J van der Geest ◽

...

Keyword(s):

Energy Loss ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri ◽

Fontan Patients

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4D flow MRI versus conventional 2D for measuring pulmonary flow after Tetralogy of Fallot repair

International Journal of Cardiology ◽

10.1016/j.ijcard.2019.10.030 ◽

2020 ◽

Vol 300 ◽

pp. 132-136 ◽

Cited By ~ 2

Author(s):

M.A. Isorni ◽

D. Martins ◽

N. Ben Moussa ◽

S. Monnot ◽

N. Boddaert ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

4D Flow Mri ◽

4D Flow ◽

Pulmonary Flow ◽

Flow Mri ◽

Tetralogy Of Fallot Repair

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Standardized Evaluation of Cerebral Arteriovenous Malformations Using Flow Distribution Network Graphs and Dual‐ venc 4D Flow MRI

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.26784 ◽

2019 ◽

Vol 50 (6) ◽

pp. 1718-1730 ◽

Cited By ~ 6

Author(s):

Maria Aristova ◽

Alireza Vali ◽

Sameer A. Ansari ◽

Ali Shaibani ◽

Tord D. Alden ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Distribution Network ◽

Flow Distribution ◽

Cerebral Arteriovenous Malformations ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri

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Hemodynamic interplay of vorticity, viscous energy loss, and kinetic energy from 4D Flow MRI and link to cardiac function in healthy subjects and Fontan patients

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00806.2020 ◽

2021 ◽

Vol 320 (4) ◽

pp. H1687-H1698

Author(s):

Vivian P. Kamphuis ◽

Arno A. W. Roest ◽

Pieter J. van den Boogaard ◽

Lucia J. M. Kroft ◽

Hildo J. Lamb ◽

...

Keyword(s):

Kinetic Energy ◽

Energy Loss ◽

Cardiovascular Magnetic Resonance Imaging ◽

Healthy Subjects ◽

Energy Levels ◽

Resonance Imaging ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri ◽

Fontan Patients

Physiologic intraventricular hemodynamic interplay/coupling is present in the healthy left ventricle between vorticity versus viscous energy loss and kinetic energy from four-dimensional flow cardiovascular magnetic resonance imaging (4D Flow MRI). Conversely, Fontan patients present compensatory pathophysiologic hemodynamic coupling by an increase in intraventricular vorticity that positively correlates to viscous energy loss and kinetic energy levels in the presence of maintained normal stroke volume. Altered vorticity and energetics are found in the presence of normal ejection fraction in Fontan patients.

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Hemodynamic Disturbances in Posterior Circulation Stroke: 4D Flow Magnetic Resonance Imaging Added to Computed Tomography Angiography

Frontiers in Neuroscience ◽

10.3389/fnins.2021.656769 ◽

2021 ◽

Vol 15 ◽

Author(s):

Jan Malm ◽

Johan Birnefeld ◽

Laleh Zarrinkoob ◽

Anders Wåhlin ◽

Anders Eklund

Keyword(s):

Magnetic Resonance Imaging ◽

Blood Flow ◽

Posterior Circulation ◽

Resonance Imaging ◽

4D Flow Mri ◽

4D Flow ◽

Flow Rates ◽

Flow Mri ◽

Hemodynamic Disturbance ◽

Relative Flow

Objective: A clinically feasible, non-invasive method to quantify blood flow, hemodynamics, and collateral flow in the vertebrobasilar arterial tree is missing. The objective of this study was to evaluate the feasibility of quantifying blood flow and blood flow patterns using 4D flow magnetic resonance imaging (MRI) in consecutive patients after an ischemic stroke in the posterior circulation. We also explore if 4D-flow, analyzed in conjunction with computed tomography angiography (CTA), has potential as a diagnostic tool in posterior circulation stroke.Methods: Twenty-five patients (mean age 62 years; eight women) with acute ischemic stroke in the posterior circulation were investigated. At admission, all patients were examined with CTA followed by MRI (4D flow MRI and diffusion-weighted sequences) at median 4 days after the presenting event. Based on the classification of Caplan, patients were divided into proximal/middle (n = 16) and distal territory infarcts (n = 9). Absolute and relative blood flow rates were calculated for internal carotid arteries (ICA), vertebral arteries (VA), basilar artery (BA), posterior cerebral arteries (P1 and P2), and the posterior communicating arteries (Pcom). In a control group consisting of healthy elderly, the 90th and 10th percentiles of flow were calculated in order to define normal, increased, or decreased blood flow in each artery. “Major hemodynamic disturbance” was defined as low BA flow and either low P2 flow or high Pcom flow. Various minor hemodynamic disturbances were also defined. Blood flow rates were compared between groups. In addition, a comprehensive analysis of each patient’s blood flow profile was performed by assessing relative blood flow rates in each artery in conjunction with findings from CTA.Results: There was no difference in total cerebral blood flow between patients and controls [604 ± 117 ml/min vs. 587 ± 169 ml/min (mean ± SD), p = 0.39] or in total inflow to the posterior circulation (i.e., the sum of total VA and Pcom flows, 159 ± 63 ml/min vs. 164 ± 52 ml/min, p = 0.98). In individual arteries, there were no significant differences between patients and controls in absolute or relative flow. However, patients had larger interindividual relative flow variance in BA, P1, and P2 (p = 0.01, <0.01, and 0.02, respectively). Out of the 16 patients that had proximal/middle territory infarcts, nine had CTA findings in VA and/or BA generating five with major hemodynamic disturbance identified with 4D flow MRI. For those without CTA findings, seven had no or minor 4D flow MRI hemodynamic disturbance. Among nine patients with distal territory infarcts, one had major hemodynamic disturbances, while the remaining had minor disturbances.Conclusion: 4D flow MRI contributed to the identification of the patients who had major hemodynamic disturbances from the vascular pathologies revealed on CTA. We thus conclude that 4D flow MRI could add valuable hemodynamic information when used in conjunction with CTA.

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