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

ABSTRACT: Long 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.

SUBMITTER: Rijnberg FM

PROVIDER: S-EPMC7985309 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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

Rijnberg Friso M FM van Assen Hans C HC Juffermans Joe F JF Kroft Lucia J M LJM van den Boogaard Pieter J PJ de Koning Patrick J H PJH Hazekamp Mark G MG van der Woude Séline F S SFS Warmerdam Evangeline G EG Leiner Tim T Grotenhuis Heynric B HB Goeman Jelle J JJ Lamb Hildo J HJ Roest Arno A W AAW Westenberg Jos J M JJM

Scientific reports 20210322 1

Long 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 fro ...[more]

PMID: 33753790

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Project description:PurposeHemodynamic atlases can add to the pathophysiological understanding of cardiac diseases. This study proposes a method to create hemodynamic atlases using 4D Flow magnetic resonance imaging (MRI). The method is demonstrated for kinetic energy (KE) and helicity density (Hd ).Materials and methodsThirteen healthy subjects underwent 4D Flow MRI at 3T. Phase-contrast magnetic resonance cardioangiographies (PC-MRCAs) and an average heart were created and segmented. The PC-MRCAs, KE, and Hd were nonrigidly registered to the average heart to create atlases. The method was compared with 1) rigid, 2) affine registration of the PC-MRCAs, and 3) affine registration of segmentations. The peak and mean KE and Hd before and after registration were calculated to evaluate interpolation error due to nonrigid registration.ResultsThe segmentations deformed using nonrigid registration overlapped (median: 92.3%) more than rigid (23.1%, P < 0.001), and affine registration of PC-MRCAs (38.5%, P < 0.001) and affine registration of segmentations (61.5%, P < 0.001). The peak KE was 4.9 mJ using the proposed method and affine registration of segmentations (P = 0.91), 3.5 mJ using rigid registration (P < 0.001), and 4.2 mJ using affine registration of the PC-MRCAs (P < 0.001). The mean KE was 1.1 mJ using the proposed method, 0.8 mJ using rigid registration (P < 0.001), 0.9 mJ using affine registration of the PC-MRCAs (P < 0.001), and 1.0 mJ using affine registration of segmentations (P = 0.028). The interpolation error was 5.2 ± 2.6% at mid-systole, 2.8 ± 3.8% at early diastole for peak KE; 9.6 ± 9.3% at mid-systole, 4.0 ± 4.6% at early diastole, and 4.9 ± 4.6% at late diastole for peak Hd . The mean KE and Hd were not affected by interpolation.ConclusionHemodynamic atlases can be obtained with minimal user interaction using nonrigid registration of 4D Flow MRI.Level of evidence2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1389-1399.

Project description:BackgroundThe Fontan procedure is a surgical intervention designed for patients with single ventricle physiology, wherein the systemic venous return is redirected into the pulmonary circulation, thereby facilitating passive pulmonary blood flow without the assistance of ventricular propulsion. Consequently, long-term follow-up of individuals who have undergone the asymptomatic Fontan procedure is essential.ObjectivesThe aims of this investigation were to: 1) examine the impact of flow components and kinetic energy (KE) parameters on hemodynamic disturbances in asymptomatic Fontan patients and control group; 2) Assess left ventricular diastolic dysfunction through the analysis of 4D flow parameters across different Fontan sub-groups; 3) Compare intracardiac flow parameters among Fontan sub-groups based on morphological features of the left ventricle (LV) and right ventricle (RV).MethodsTwenty-five Fontan patients (mean age: 10 ± 3 years, male/female: 15/10) and fourteen control subjects (mean age: 10 ± 2 years, male/female: 8/6) were recruited retrospectively for the study. The Fontan patients were further categorized into three groups based on their ventricular function: left ventricular (LV), right ventricular (RV), and biventricular (BiV). Each participant underwent cardiovascular magnetic resonance (CMR) imaging, including cine and 4D flow sequences on a 3.0 T scanner. Ventricular flow components and KE were assessed using 4D flow. The study utilized cine images to analyze cardiac function and inter-ventricular mechanical dyssynchrony. Echocardiography evaluated functional ventricular diastolic dysfunction.ResultsFontan patients had a higher median functional single ventricle (FSV) residual volume compared to controls (28 % vs. 23 %, P = 0.034), with lower median FSV direct flow (32 % vs. 40 %, P = 0.005) and delayed ejection flow (17 % vs. 24 %, P = 0.024). The parameters of FSV normalized to the ventricular end-diastolic volume (KEiEDV) were found to be significantly lower in Fontan patients (all P < 0.05). In both left ventricle (LV) and biventricular (BiV) Fontan subgroups, direct flow was identified as an independent predictor of LV diastolic dysfunction (AUC=0.76, Sensitivity=86 %, Specificity=70 %). Furthermore, residual volume and E-wave KEiEDV were observed to be significantly different between LV and right ventricle (RV) Fontan subgroups.ConclusionsThe altered flow pattern and reduced kinetic energy observed in Fontan patients may indicate hemodynamic disturbances and compromised ventricular filling. Reduced direct flow is associated with LV diastolic dysfunction in LV and BiV Fontan subgroups. Systemic LV exhibited a more efficient intracardiac flow pattern compare with systemic RV in Fontan patients.

Project description:PurposeTo generate fully automated and fast 4D-flow MRI-based 3D segmentations of the aorta using deep learning for reproducible quantification of aortic flow, peak velocity, and dimensions.MethodsA total of 1018 subjects with aortic 4D-flow MRI (528 with bicuspid aortic valve, 376 with tricuspid aortic valve and aortic dilation, 114 healthy controls) comprised the data set. A convolutional neural network was trained to generate 3D aortic segmentations from 4D-flow data. Manual segmentations served as the ground truth (N = 499 training, N = 101 validation, N = 418 testing). Dice scores, Hausdorff distance, and average symmetrical surface distance were calculated to assess performance. Aortic flow, peak velocity, and lumen dimensions were quantified at the ascending, arch, and descending aorta and compared using Bland-Altman analysis. Interobserver variability of manual analysis was assessed on a subset of 40.ResultsConvolutional neural network segmentation required 0.438 ± 0.355 seconds versus 630 ± 254 seconds for manual analysis and demonstrated excellent performance with a median Dice score of 0.951 (0.930-0.966), Hausdorff distance of 2.80 (2.13-4.35), and average symmetrical surface distance of 0.176 (0.119-0.290). Excellent agreement was found for flow, peak velocity, and dimensions with low bias and limits of agreement less than 10% difference versus manual analysis. For aortic volume, limits of agreement were moderate within 16.3%. Interobserver variability (median Dice score: 0.950; Hausdorff distance: 2.45; and average symmetrical surface distance: 0.145) and convolutional neural network-based analysis (median Dice score: 0.953-0.959; Hausdorff distance: 2.24-2.91; and average symmetrical surface distance: 0.145-1.98 to observers) demonstrated similar reproducibility.ConclusionsDeep learning enabled fast and automated 3D aortic segmentation from 4D-flow MRI, demonstrating its potential for efficient clinical workflows. Future studies should investigate its utility for other vasculature and multivendor applications.

Dataset Information

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

Publications

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

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