Abstract
Background: Cardiac MRI plays a central role in monitoring children with repaired tetralogy of Fallot (TOF) for long-term complications. Current risk assessment is based on volumetric and functional parameters that measure late expression of underlying physiological changes. Emerging 4-D flow MRI techniques promise new insights. Objective: To assess whether 4-D flow MRI-derived measures of blood kinetic energy (1) differentiate children and young adults with TOF from controls and (2) are associated with disease severity. Materials and methods: Pediatric patients post TOF repair (n=21) and controls (n=24) underwent 4-D flow MRI for assessment of time-resolved 3-D blood flow. Data analysis included 3-D segmentation of the right ventricle (RV) and pulmonary artery (PA), with calculation of peak systolic and diastolic kinetic energy (KE) maps. Total KE RV and KE PA were determined from the sum of the KE of all voxels within the respective time-resolved segmentations. Results: KE PA was increased in children post TOF vs. controls across the cardiac cycle, with median 12.5 (interquartile range [IQR] 10.3) mJ/m 2 vs. 8.2 (4.3) mJ/m 2 , P<0.01 in systole; and 2.3 (2.7) mJ/m 2 vs. 1.4 (0.9) mJ/m 2 , P<0.01 in diastole. Diastolic KE PA correlated with systolic KE PA (R 2 0.41, P<0.01) and with pulmonary regurgitation fraction (R 2 0.65, P<0.01). Diastolic KE RV showed similar relationships, denoting increasing KE with higher cardiac outputs and increased right heart volume loading. Diastolic KE RV and KE PA increased with RV end-diastolic volume in a non-linear relationship (R 2 0.33, P<0.01 and R 2 0.50, P<0.01 respectively), with an inflection point near 120 mL/m 2 . Conclusion: Four-dimensional flow-derived KE is abnormal in pediatric patients post TOF repair compared to controls and has a direct, non-linear relationship with traditional measures of disease progression. Future longitudinal studies are needed to evaluate utility for early outcome prediction in TOF.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 308-317 |
| Number of pages | 10 |
| Journal | Pediatric radiology |
| Volume | 49 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 7 2019 |
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Keywords
- 4-D flow
- Children
- Congenital heart disease
- Heart
- Kinetic energy
- Magnetic resonance imaging
- Pulmonary artery
- Right ventricle
- Tetralogy of Fallot
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Radiology Nuclear Medicine and imaging
Cite this
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4-D flow magnetic-resonance-imaging-derived energetic biomarkers are abnormal in children with repaired tetralogy of Fallot and associated with disease severity. / Robinson, Joshua D; Rose, Michael J.; Joh, Maria; Jarvis, Kelly; Schnell, Susanne; Barker, Alex J.; Rigsby, Cynthia K; Markl, Michael.
In: Pediatric radiology, Vol. 49, No. 3, 07.03.2019, p. 308-317.Research output: Contribution to journal › Article
TY - JOUR
T1 - 4-D flow magnetic-resonance-imaging-derived energetic biomarkers are abnormal in children with repaired tetralogy of Fallot and associated with disease severity
AU - Robinson, Joshua D
AU - Rose, Michael J.
AU - Joh, Maria
AU - Jarvis, Kelly
AU - Schnell, Susanne
AU - Barker, Alex J.
AU - Rigsby, Cynthia K
AU - Markl, Michael
PY - 2019/3/7
Y1 - 2019/3/7
N2 - Background: Cardiac MRI plays a central role in monitoring children with repaired tetralogy of Fallot (TOF) for long-term complications. Current risk assessment is based on volumetric and functional parameters that measure late expression of underlying physiological changes. Emerging 4-D flow MRI techniques promise new insights. Objective: To assess whether 4-D flow MRI-derived measures of blood kinetic energy (1) differentiate children and young adults with TOF from controls and (2) are associated with disease severity. Materials and methods: Pediatric patients post TOF repair (n=21) and controls (n=24) underwent 4-D flow MRI for assessment of time-resolved 3-D blood flow. Data analysis included 3-D segmentation of the right ventricle (RV) and pulmonary artery (PA), with calculation of peak systolic and diastolic kinetic energy (KE) maps. Total KE RV and KE PA were determined from the sum of the KE of all voxels within the respective time-resolved segmentations. Results: KE PA was increased in children post TOF vs. controls across the cardiac cycle, with median 12.5 (interquartile range [IQR] 10.3) mJ/m 2 vs. 8.2 (4.3) mJ/m 2 , P<0.01 in systole; and 2.3 (2.7) mJ/m 2 vs. 1.4 (0.9) mJ/m 2 , P<0.01 in diastole. Diastolic KE PA correlated with systolic KE PA (R 2 0.41, P<0.01) and with pulmonary regurgitation fraction (R 2 0.65, P<0.01). Diastolic KE RV showed similar relationships, denoting increasing KE with higher cardiac outputs and increased right heart volume loading. Diastolic KE RV and KE PA increased with RV end-diastolic volume in a non-linear relationship (R 2 0.33, P<0.01 and R 2 0.50, P<0.01 respectively), with an inflection point near 120 mL/m 2 . Conclusion: Four-dimensional flow-derived KE is abnormal in pediatric patients post TOF repair compared to controls and has a direct, non-linear relationship with traditional measures of disease progression. Future longitudinal studies are needed to evaluate utility for early outcome prediction in TOF.
AB - Background: Cardiac MRI plays a central role in monitoring children with repaired tetralogy of Fallot (TOF) for long-term complications. Current risk assessment is based on volumetric and functional parameters that measure late expression of underlying physiological changes. Emerging 4-D flow MRI techniques promise new insights. Objective: To assess whether 4-D flow MRI-derived measures of blood kinetic energy (1) differentiate children and young adults with TOF from controls and (2) are associated with disease severity. Materials and methods: Pediatric patients post TOF repair (n=21) and controls (n=24) underwent 4-D flow MRI for assessment of time-resolved 3-D blood flow. Data analysis included 3-D segmentation of the right ventricle (RV) and pulmonary artery (PA), with calculation of peak systolic and diastolic kinetic energy (KE) maps. Total KE RV and KE PA were determined from the sum of the KE of all voxels within the respective time-resolved segmentations. Results: KE PA was increased in children post TOF vs. controls across the cardiac cycle, with median 12.5 (interquartile range [IQR] 10.3) mJ/m 2 vs. 8.2 (4.3) mJ/m 2 , P<0.01 in systole; and 2.3 (2.7) mJ/m 2 vs. 1.4 (0.9) mJ/m 2 , P<0.01 in diastole. Diastolic KE PA correlated with systolic KE PA (R 2 0.41, P<0.01) and with pulmonary regurgitation fraction (R 2 0.65, P<0.01). Diastolic KE RV showed similar relationships, denoting increasing KE with higher cardiac outputs and increased right heart volume loading. Diastolic KE RV and KE PA increased with RV end-diastolic volume in a non-linear relationship (R 2 0.33, P<0.01 and R 2 0.50, P<0.01 respectively), with an inflection point near 120 mL/m 2 . Conclusion: Four-dimensional flow-derived KE is abnormal in pediatric patients post TOF repair compared to controls and has a direct, non-linear relationship with traditional measures of disease progression. Future longitudinal studies are needed to evaluate utility for early outcome prediction in TOF.
KW - 4-D flow
KW - Children
KW - Congenital heart disease
KW - Heart
KW - Kinetic energy
KW - Magnetic resonance imaging
KW - Pulmonary artery
KW - Right ventricle
KW - Tetralogy of Fallot
UR - http://www.scopus.com/inward/record.url?scp=85057851137&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85057851137&partnerID=8YFLogxK
U2 - 10.1007/s00247-018-4312-8
DO - 10.1007/s00247-018-4312-8
M3 - Article
VL - 49
SP - 308
EP - 317
JO - Pediatric Radiology
JF - Pediatric Radiology
SN - 0301-0449
IS - 3
ER -