Four-Dimensional flow magnetic resonance imaging in cardiovascular diseases: Who can benefit?

Abstract

Four-dimensional flow cardiac magnetic resonance (4D CMR) is an emerging imaging modality for qualitative and quantitative analysis of cardiovascular pathologies. Despite numerous advantages, its distribution and use remain limited suggesting practical or technical difficulties in using this technique routinely. We sought to report our preliminary experience in real life of 4D CMR in unselected children with congenital heart disease (CHD). We focused on its feasibility and ability, compared with adults with CHD as control. We herein report 50 4D CMR examinations over a one-year study period. This modality has been applied as a complementary imaging when conventional imaging modalities were unsatisfactory. Quality was classified according to qualitative and quantitative criteria by two blinded radiologists. This study included 22 children and 28 adults (mean age 29.5 ± 18.5 years old [0.3; 54], mean weight 61.0 ± 22.7 kg [3.8; 105.0], mean height 159.8 ± 5.5 cm [52; 192]). In infant and children mean age was 10.6 ± 6.1 years old [0.3; 18], mean weight was 36.8 ± 24.5 kg [3.8; 105.0], mean height was 149.4 ± 42.1 cm [52; 192]. Clinical indications were 36% of tetralogy of Fallot, 18% of aorta disease, 27% of complex CHD, 9% of ventricular septal defect and 10% of valvulopathy. The feasibility of this examination was excellent, while 100% exams were performed with no need for general anesthesia whatever the indication or patient (infant, child or adult). Average duration of exams were 465 ± 90s [339–610]. The overall quality of exams was satisfactory; 63% of good quality and 23% of medium quality. The evolution of quality over time has shown a progressive improvement which seems to correspond to a 3-month long learning curve. The only predictive factor identified for quality was the experience (X 2 = 4.8; P = 0.03 in CHD). Based on our preliminary experience, 4D Flow has become a complementary imaging modality accessible in current practice and open to all patients, infant, child or adult, without restriction of age, weight, size or pathology. The quality of this examination was satisfactory and seems to require an estimated learning curve of 3 months according to our experience.