Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: appli
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Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: application in neonates and young children Julia Geiger 1,2 & Fraser M. Callaghan 2,3 & Barbara E. U. Burkhardt 2,4 & Emanuela R. Valsangiacomo Buechel 2,4 & Christian J. Kellenberger 1,2 Received: 12 May 2020 / Revised: 8 August 2020 / Accepted: 12 October 2020 # The Author(s) 2020
Abstract Cardiovascular MRI has become an essential imaging modality in children with congenital heart disease (CHD) in the last 15– 20 years. With use of appropriate sequences, it provides important information on cardiovascular anatomy, blood flow and function for initial diagnosis and post-surgical or -interventional monitoring in children. Although considered as more sophisticated and challenging than CT, in particular in neonates and infants, MRI is able to provide information on intra- and extracardiac haemodynamics, in contrast to CT. In recent years, four-dimensional (4-D) flow MRI has emerged as an additional MR technique for retrospective assessment and visualisation of blood flow within the heart and any vessel of interest within the acquired threedimensional (3-D) volume. Its application in young children requires special adaptations for the smaller vessel size and faster heart rate compared to adolescents or adults. In this article, we provide an overview of 4-D flow MRI in various types of complex CHD in neonates and infants to demonstrate its potential indications and beneficial application for optimised individual cardiovascular assessment. We focus on its application in clinical routine cardiovascular workup and, in addition, show some examples with pathologies other than CHD to highlight that 4-D flow MRI yields new insights in disease understanding and therapy planning. We shortly review the essentials of 4-D flow data acquisition, pre- and post-processing techniques in neonates, infants and young children. Finally, we conclude with some details on accuracy, limitations and pitfalls of the technique. Keywords Children . Congenital heart disease . Four-dimensional flow . Heart . Magnetic resonance imaging . Neonates
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00247-020-04885-w) contains supplementary material, which is available to authorized users. * Julia Geiger [email protected] 1
Department of Diagnostic Imaging, University Children’s Hospital Zürich, Steinwiesstr 75, 8032 Zürich, Switzerland
2
Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland
3
Center for MR research, University Children’s Hospital Zürich, Zürich, Switzerland
4
Department of Pediatric Cardiology, University Hospital Zürich, Zürich, Switzerland
Cardiovascular MRI has become a complementary modality to echocardiography and a valuable alternative to conventional Xray angiography and CT in neonates and young children with congenital heart disease (CHD) for preoperative assessment of cardiovascular anatomy
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