Ayah Elsayed1, Kathleen Gilbert2, Miriam Scadeng1, Brett R Cowan3, Kuberan Pushparajah4, Alistair A Young5,6. 1. Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand. 2. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand. 3. Institute of Environmental Science and Research, Auckland, New Zealand. 4. Department of Biomedical Engineering, King's College London, London, UK. 5. Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand. Alistair.Young@kcl.ac.uk. 6. Department of Biomedical Engineering, King's College London, London, UK. Alistair.Young@kcl.ac.uk.
Abstract
BACKGROUND: Patients with repaired Tetralogy of Fallot (rTOF) often develop cardiovascular dysfunction and require regular imaging to evaluate deterioration and time interventions such as pulmonary valve replacement. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) enables detailed assessment of flow characteristics in all chambers and great vessels. We performed a systematic review of intra-cardiac 4D flow applications in rTOF patients, to examine clinical utility and highlight optimal methods for evaluating rTOF patients. METHODS: A comprehensive literature search was undertaken in March 2020 on Google Scholar and Scopus. A modified version of the Critical Appraisal Skills Programme (CASP) tool was used to assess and score the applicability of each study. Important clinical outcomes were assessed including similarities and differences. RESULTS: Of the 635 articles identified, 26 studies met eligibility for systematic review. None of these were below 59% applicability on the modified CASP score. Studies could be broadly classified into four groups: (i) pilot studies, (ii) development of new acquisition methods, (iii) validation and (vi) identification of novel flow features. Quantitative comparison with other modalities included 2D phase contrast CMR (13 studies) and echocardiography (4 studies). The 4D flow study applications included stroke volume (18/26;69%), regurgitant fraction (16/26;62%), relative branch pulmonary artery flow(4/26;15%), systolic peak velocity (9/26;35%), systemic/pulmonary total flow ratio (6/26;23%), end diastolic and end systolic volume (5/26;19%), kinetic energy (5/26;19%) and vorticity (2/26;8%). CONCLUSIONS: 4D flow CMR shows potential in rTOF assessment, particularly in retrospective valve tracking for flow evaluation, velocity profiling, intra-cardiac kinetic energy quantification, and vortex visualization. Protocols should be targeted to pathology. Prospective, randomized, multi-centered studies are required to validate these new characteristics and establish their clinical use.
BACKGROUND:Patients with repaired Tetralogy of Fallot (rTOF) often develop cardiovascular dysfunction and require regular imaging to evaluate deterioration and time interventions such as pulmonary valve replacement. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) enables detailed assessment of flow characteristics in all chambers and great vessels. We performed a systematic review of intra-cardiac 4D flow applications in rTOF patients, to examine clinical utility and highlight optimal methods for evaluating rTOF patients. METHODS: A comprehensive literature search was undertaken in March 2020 on Google Scholar and Scopus. A modified version of the Critical Appraisal Skills Programme (CASP) tool was used to assess and score the applicability of each study. Important clinical outcomes were assessed including similarities and differences. RESULTS: Of the 635 articles identified, 26 studies met eligibility for systematic review. None of these were below 59% applicability on the modified CASP score. Studies could be broadly classified into four groups: (i) pilot studies, (ii) development of new acquisition methods, (iii) validation and (vi) identification of novel flow features. Quantitative comparison with other modalities included 2D phase contrast CMR (13 studies) and echocardiography (4 studies). The 4D flow study applications included stroke volume (18/26;69%), regurgitant fraction (16/26;62%), relative branch pulmonary artery flow(4/26;15%), systolic peak velocity (9/26;35%), systemic/pulmonary total flow ratio (6/26;23%), end diastolic and end systolic volume (5/26;19%), kinetic energy (5/26;19%) and vorticity (2/26;8%). CONCLUSIONS: 4D flow CMR shows potential in rTOF assessment, particularly in retrospective valve tracking for flow evaluation, velocity profiling, intra-cardiac kinetic energy quantification, and vortex visualization. Protocols should be targeted to pathology. Prospective, randomized, multi-centered studies are required to validate these new characteristics and establish their clinical use.
Entities:
Keywords:
4D flow; Cardiovascular magnetic resonance; Tetralogy of Fallot
Authors: Albert Hsiao; Marcus T Alley; Payam Massaband; Robert J Herfkens; Frandics P Chan; Shreyas S Vasanawala Journal: Pediatr Radiol Date: 2011-01-11
Authors: A Hrusca; A L Rachisan; P Gach; H Pico; C Sorensen; B Bonello; C Ovaert; P Petit; V Fouilloux; L Mace; G Gorincour Journal: Diagn Interv Imaging Date: 2016-04-23 Impact factor: 4.026
Authors: David M Harrild; Edward Marcus; Babar Hasan; Mark E Alexander; Andrew J Powell; Tal Geva; Doff B McElhinney Journal: Circ Cardiovasc Interv Date: 2013-12-03 Impact factor: 6.546
Authors: Xiaodan Zhao; Liwei Hu; Shuang Leng; Ru-San Tan; Ping Chai; Jennifer Ann Bryant; Lynette L S Teo; Marielle V Fortier; Tee Joo Yeo; Rong Zhen Ouyang; John C Allen; Marina Hughes; Pankaj Garg; Shuo Zhang; Rob J van der Geest; James W Yip; Teng Hong Tan; Ju Le Tan; Yumin Zhong; Liang Zhong Journal: J Cardiovasc Magn Reson Date: 2022-01-03 Impact factor: 5.364