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Comparative Study
. 2024 Dec;45(8):1627-1635.
doi: 10.1007/s00246-023-03238-2. Epub 2023 Jul 24.

Comparison of Four-Dimensional Flow MRI, Two-Dimensional Phase-Contrast MRI and Echocardiography in Transposition of the Great Arteries

Evangeline G Warmerdam  1   2 , Jos J M Westenberg  3 , Michiel Voskuil  4 , Friso M Rijnberg  5 , Arno A W Roest  6 , Hildo J Lamb  3 , Bram van Wijk  7 , Gertjan T Sieswerda  4 , Pieter A Doevendans  4   8 , Henriette Ter Heide  9 , Gregor J Krings  9 , Tim Leiner  10 , Heynric B Grotenhuis  9
Affiliations
Comparative Study

Comparison of Four-Dimensional Flow MRI, Two-Dimensional Phase-Contrast MRI and Echocardiography in Transposition of the Great Arteries

Evangeline G Warmerdam et al. Pediatr Cardiol. 2024 Dec.

Abstract

Pulmonary artery (PA) stenosis is a common complication after the arterial switch operation (ASO) for transposition of the great arteries (TGA). Four-dimensional flow (4D flow) CMR provides the ability to quantify flow within an entire volume instead of a single plane. The aim of this study was to compare PA maximum velocities and stroke volumes between 4D flow CMR, two-dimensional phase-contrast (2D PCMR) and echocardiography. A prospective study including TGA patients after ASO was performed between December 2018 and October 2020. All patients underwent echocardiography and CMR, including 2D PCMR and 4D flow CMR. Maximum velocities and stroke volumes were measured in the main, right, and left PA (MPA, LPA, and RPA, respectively). A total of 39 patients aged 20 ± 8 years were included. Maximum velocities in the MPA, LPA, and RPA measured by 4D flow CMR were significantly higher compared to 2D PCMR (p < 0.001 for all). PA assessment by echocardiography was not possible in the majority of patients. 4D flow CMR maximum velocity measurements were consistently higher than those by 2D PCMR with a mean difference of 65 cm/s for the MPA, and 77 cm/s for both the RPA and LPA. Stroke volumes showed good agreement between 4D flow CMR and 2D PCMR. Maximum velocities in the PAs after ASO for TGA are consistently lower by 2D PCMR, while echocardiography only allows for PA assessment in a minority of cases. Stroke volumes showed good agreement between 4D flow CMR and 2D PCMR.

Keywords: Advanced cardiac imaging; Congenital heart disease; Magnetic resonance imaging; Transposition of the great arteries.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Comparison of maximum velocities in the main, right, and left pulmonary artery as measured by two-dimensional flow phase-contrast cardiac magnetic resonance, four-dimensional flow cardiac magnetic resonance and Doppler echocardiography. 2D PC CMR two-dimensional phase-contrast cardiac magnetic resonance, 4D flow CMR four-dimensional flow cardiac magnetic resonance, MPA main pulmonary artery, LPA left pulmonary artery, RPA right pulmonary artery
Fig. 2
Fig. 2
Agreement between four-dimensional flow cardiac magnetic resonance and two-dimensional phase-contrast cardiac magnetic resonance for measurement of maximum velocities in the main, right, and left pulmonary artery (left) and agreement between four-dimensional flow cardiac magnetic resonance and Doppler echocardiography of maximum velocities in the main, right, and left pulmonary artery (right). 2D two-dimensional phase-contrast cardiac magnetic resonance, 4D four-dimensional flow cardiac magnetic resonance, echo doppler echocardiography, MPA main pulmonary artery, LPA left pulmonary artery, RPA right pulmonary artery
Fig. 3
Fig. 3
Agreement between four-dimensional flow cardiac magnetic resonance and two-dimensional phase-contrast cardiac magnetic resonance for measurement of stroke volumes (forward flow–regurgitant flow) in the main, right, and left pulmonary artery. 2D two-dimensional phase-contrast cardiac magnetic resonance, 4D four-dimensional flow cardiac magnetic resonance, MPA main pulmonary artery, LPA left pulmonary artery, RPA right pulmonary artery
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