4D flow MRI applications in congenital heart disease
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CARDIAC
4D flow MRI applications in congenital heart disease Judy Rizk 1 Received: 10 December 2019 / Revised: 4 July 2020 / Accepted: 19 August 2020 # European Society of Radiology 2020
Abstract Advances in the diagnosis and management of congenital heart disease (CHD) have resulted in a growing population of patients surviving well into adulthood and requiring lifelong follow-up. Flow quantification is a central component in the assessment of patients with CHD. 4D flow magnetic resonance imaging (MRI) has emerged as a tool that enables comprehensive study of flow. It involves the acquisition of a three-dimensional time-resolved volume with velocity encoding in all three spatial directions along the cardiac cycle. This allows flow quantification and visualization of blood flow patterns as well as the study of advanced hemodynamic parameters as kinetic energy and wall shear stress. 4D flow MRI-based study of flow has given insight into the altered hemodynamics in CHD particularly in bicuspid aortic valve disease and Fontan circulation. The aim of this review is to discuss the expanding clinical and research applications of 4D flow MRI in CHD as well its limitations. Key Points • Three-dimensional velocity encoding allows not only flow quantification but also the visualization of multidirectional flow patterns and the study of advanced hemodynamic parameters. • 4D flow MRI has added insight into the abnormal hemodynamics involved in congenital heart disease in particular in bicuspid aortic valve and Fontan circulation. • The main limitation of 4D flow MRI in congenital heart disease is the relatively long scan duration required for the complete coverage of the heart and great vessels with adequate spatiotemporal resolution. Keywords Magnetic resonance imaging . Hemodynamics . Heart defects . Congenital
Abbreviations 2D Two-dimensional 4D Four-dimensional AVSD Atrioventricular septal defect BAV Bicuspid aortic valve BLAST Broad linear speed-up technique CHD Congenital heart disease ECG Electrocardiography EL Energy loss GRAPPA Generalized Autocalibrating Partially Parallel Acquisition IVC Inferior vena cava KE Kinetic energy LAVV Left atrioventricular valve LV Left ventricle * Judy Rizk [email protected] 1
Department of Cardiology, Faculty of Medicine, Alexandria University, El-Khartoum Square, Alexandria 21521, Egypt
MRI PC PR RL-BAV RN-BAV RV SENSE TCPC TOF VENC VIPR WSS
Magnetic resonance imaging Phase contrast Pulmonary regurgitation Right–left cusp fusion bicuspid aortic valve Right-noncoronary cusp fusion bicuspid aortic valve Right ventricle Sensitivity encoding Total cavopulmonary connection Tetralogy of Fallot Velocity encoding Vastly undersampled isotropic projection reconstruction Wall shear stress
Congenital heart disease (CHD) is the most common birth defect with an average birth prevalence of about 1% [1, 2]. Advances in the diagnosis and management of CHD have resulted in improved survival and an increasing number of
Eur Radiol
patients surviving to adulthood [3] requiring lifelong followup to
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