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Comparison of 2D and 4D Flow MRI in Neonates Without General Anesthesia

Sjöberg, Pia LU orcid ; Hedström, Erik LU orcid ; Fricke, Katrin LU ; Frieberg, Petter LU ; Weismann, Constance Gesina LU orcid ; Liuba, Petru LU ; Carlsson, Marcus LU and Toger, Johannes LU (2023) In Journal of Magnetic Resonance Imaging 57(1). p.71-82
Abstract
Background
Neonates with critical congenital heart disease require early intervention. Four-dimensional (4D) flow may facilitate surgical planning and improve outcome, but accuracy and precision in neonates are unknown.

Purpose
To 1) validate two-dimensional (2D) and 4D flow MRI in a phantom and investigate the effect of spatial and temporal resolution; 2) investigate accuracy and precision of 4D flow and internal consistency of 2D and 4D flow in neonates; and 3) compare scan time of 4D flow to multiple 2D flows.

Study Type
Phantom and prospective patients.

Population
A total of 17 neonates with surgically corrected aortic coarctation (age 18 days [IQR 11–20]) and a three-dimensional printed... (More)
Background
Neonates with critical congenital heart disease require early intervention. Four-dimensional (4D) flow may facilitate surgical planning and improve outcome, but accuracy and precision in neonates are unknown.

Purpose
To 1) validate two-dimensional (2D) and 4D flow MRI in a phantom and investigate the effect of spatial and temporal resolution; 2) investigate accuracy and precision of 4D flow and internal consistency of 2D and 4D flow in neonates; and 3) compare scan time of 4D flow to multiple 2D flows.

Study Type
Phantom and prospective patients.

Population
A total of 17 neonates with surgically corrected aortic coarctation (age 18 days [IQR 11–20]) and a three-dimensional printed neonatal aorta phantom.

Field Strength/Sequence
A 5 T, 2D flow and 4D flow.

Assessment
In the phantom, 2D and 4D flow volumes (ascending and descending aorta, and aortic arch vessels) with different resolutions were compared to high-resolution reference 2D flow. In neonates, 4D flow was compared to 2D flow volumes at each vessel. Internal consistency was computed as the flow volume in the ascending aorta minus the sum of flow volumes in the aortic arch vessels and descending aorta, divided by ascending aortic flow.

Statistical tests
Bland–Altman plots, Pearson correlation coefficient (r), and Student's t-tests.

Results
In the phantom, 2D flow differed by 0.01 ± 0.02 liter/min with 1.5 mm spatial resolution and −0.01 ± 0.02 liter/min with 0.8 mm resolution; 4D flow differed by −0.05 ± 0.02 liter/min with 2.4 mm spatial and 42 msec temporal resolution, −0.01 ± 0.02 liter/min with 1.5 mm, 42 msec resolution and −0.01 ± 0.02 liter/min with 1.5 mm, 21 msec resolution. In patients, 4D flow and 2D flow differed by −0.06 ± 0.08 liter/min. Internal consistency in patients was −11% ± 17% for 2D flow and 5% ± 13% for 4D flow. Scan time was 17.1 minutes [IQR 15.5–18.5] for 2D flow and 6.2 minutes [IQR 5.3–6.9] for 4D flow, P < 0.0001.

Data Conclusion
Neonatal 4D flow MRI is time efficient and can be acquired with good internal consistency without contrast agents or general anesthesia, thus potentially expanding 4D flow use to the youngest and smallest patients.

Evidence Level
1

Technical Efficacy
Stage 2 (Less)
Please use this url to cite or link to this publication:
author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Magnetic Resonance Imaging
volume
57
issue
1
pages
71 - 82
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:85132190894
  • pmid:35726779
ISSN
1522-2586
DOI
10.1002/jmri.28303
language
English
LU publication?
yes
id
f86e1fa3-9ff0-43f5-8cb8-d0ea952c0679
date added to LUP
2022-06-26 22:55:32
date last changed
2024-11-13 18:12:04
@article{f86e1fa3-9ff0-43f5-8cb8-d0ea952c0679,
  abstract     = {{Background<br/>Neonates with critical congenital heart disease require early intervention. Four-dimensional (4D) flow may facilitate surgical planning and improve outcome, but accuracy and precision in neonates are unknown.<br/><br/>Purpose<br/>To 1) validate two-dimensional (2D) and 4D flow MRI in a phantom and investigate the effect of spatial and temporal resolution; 2) investigate accuracy and precision of 4D flow and internal consistency of 2D and 4D flow in neonates; and 3) compare scan time of 4D flow to multiple 2D flows.<br/><br/>Study Type<br/>Phantom and prospective patients.<br/><br/>Population<br/>A total of 17 neonates with surgically corrected aortic coarctation (age 18 days [IQR 11–20]) and a three-dimensional printed neonatal aorta phantom.<br/><br/>Field Strength/Sequence<br/>A 5 T, 2D flow and 4D flow.<br/><br/>Assessment<br/>In the phantom, 2D and 4D flow volumes (ascending and descending aorta, and aortic arch vessels) with different resolutions were compared to high-resolution reference 2D flow. In neonates, 4D flow was compared to 2D flow volumes at each vessel. Internal consistency was computed as the flow volume in the ascending aorta minus the sum of flow volumes in the aortic arch vessels and descending aorta, divided by ascending aortic flow.<br/><br/>Statistical tests<br/>Bland–Altman plots, Pearson correlation coefficient (r), and Student's t-tests.<br/><br/>Results<br/>In the phantom, 2D flow differed by 0.01 ± 0.02 liter/min with 1.5 mm spatial resolution and −0.01 ± 0.02 liter/min with 0.8 mm resolution; 4D flow differed by −0.05 ± 0.02 liter/min with 2.4 mm spatial and 42 msec temporal resolution, −0.01 ± 0.02 liter/min with 1.5 mm, 42 msec resolution and −0.01 ± 0.02 liter/min with 1.5 mm, 21 msec resolution. In patients, 4D flow and 2D flow differed by −0.06 ± 0.08 liter/min. Internal consistency in patients was −11% ± 17% for 2D flow and 5% ± 13% for 4D flow. Scan time was 17.1 minutes [IQR 15.5–18.5] for 2D flow and 6.2 minutes [IQR 5.3–6.9] for 4D flow, P &lt; 0.0001.<br/><br/>Data Conclusion<br/>Neonatal 4D flow MRI is time efficient and can be acquired with good internal consistency without contrast agents or general anesthesia, thus potentially expanding 4D flow use to the youngest and smallest patients.<br/><br/>Evidence Level<br/>1<br/><br/>Technical Efficacy<br/>Stage 2}},
  author       = {{Sjöberg, Pia and Hedström, Erik and Fricke, Katrin and Frieberg, Petter and Weismann, Constance Gesina and Liuba, Petru and Carlsson, Marcus and Toger, Johannes}},
  issn         = {{1522-2586}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{71--82}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Journal of Magnetic Resonance Imaging}},
  title        = {{Comparison of 2D and 4D Flow MRI in Neonates Without General Anesthesia}},
  url          = {{http://dx.doi.org/10.1002/jmri.28303}},
  doi          = {{10.1002/jmri.28303}},
  volume       = {{57}},
  year         = {{2023}},
}