Direct jet measurement with 4D-flow MRI showed the highest correlation with mean regurgitant volume (r=0.95) and severity markers compared to indirect 2D and 4D methods in Ebstein's anomaly.
Observational (n=33)
Does 4D-flow MRI provide better correlation with severity markers compared to 2D-flow MRI for quantifying tricuspid regurgitation in adults with Ebstein's anomaly?
4D-flow MRI using the direct jet method outperforms indirect 2D and 4D approaches for quantifying tricuspid regurgitant volume in adults with Ebstein's anomaly.
Effect estimate: r = 0.95
p-value: p=<0.05
BACKGROUND: Ebstein's anomaly (EA) is a congenital heart disorder involving tricuspid valve dysplasia and right heart abnormalities resulting in severe tricuspid regurgitation (TR). Multiple techniques assess regurgitation severity, but their correlation with EA severity markers remains unclear. PURPOSE: To compare MRI techniques for quantifying TR and regurgitant volume (RVol) in adults with EA. STUDY TYPE: Retrospective. SUBJECTS: Thirty-three adult patients with EA (15 males/18 females). FIELD STRENGTH/SEQUENCE: 3T or 1.5-Tesla, 2D-phase contrast (2D-PC gradient echo) and 4D-flow (gradient echo). ASSESSMENT: RVol was measured using three methods: (1) 2D-indirect: subtraction of systolic pulmonary artery (PA) forward flow (2D-PC) from functional right ventricular stroke volume (fRVSV); (2) 4D-indirect: subtraction of PA systolic forward flow from tricuspid diastolic forward flow using 4D-flow; (3) 4D-direct: direct jet measurement with 4D-flow. Correlations were evaluated between RVol and severity markers (left ventricular ejection fraction LVEF, functional right ventricular end-diastolic volume fRVEDV, fRV/LV ratio, severity index volume, total right/left volume index, fRVEF). STATISTICAL TESTS: Pearson or Spearman correlation coefficients (p < 0.05) significant. RESULTS: The 4D-direct method had the highest correlation with the mean RVol (2D-indirect: r = 0.93, 4D-indirect: r = 0.93; 4D-direct: r = 0.95) and with severity markers: total right/left volume index (0.84, 0.64, 0.87), the fRVEDV (0.66, 0.58, 0.71), fRV/LVratio (0.81, 0.75, 0.87), and severity index volume (0.45, 0.59, 0.66). DATA CONCLUSION: 4D-flow enables intrinsic RVol quantification independent of fRV segmentation, with the direct jet method outperforming indirect approaches. TECHNICAL EFFICACY: Stage 2.
Buffle et al. (Wed,) conducted a observational in Ebstein's anomaly (n=33). 4D-flow MRI (direct jet measurement) vs. 2D-indirect and 4D-indirect MRI methods was evaluated on Correlation of regurgitant volume with severity markers (r = 0.95, p=<0.05). Direct jet measurement with 4D-flow MRI showed the highest correlation with mean regurgitant volume (r=0.95) and severity markers compared to indirect 2D and 4D methods in Ebstein's anomaly.