Quantification of Tricuspid Valve Regurgitation With 2D and 4D ‐Flow MRI : Comparison of Different Methods in Adult Patients With Ebstein's Anomaly

Figures

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  FIGURE 1. A schematic representation of the different regions in which those volumes were measured as well as their phase in the cardiac cycle and a corresponding 2D‐PC or 4D‐flow MRI flow profile. Assumption and equations used to calculate the RVol and RF with the different methods. Abbreviations: aRV: atrialized right ventricle, EDV: end‐diastolic volume, ESV: end‐systolic volume, fRV: functional right ventricle, FVol: forward volume, NVol: net volume, PA: pulmonary artery, RVol: regurgitant volume, SV: stroke volume, TV: tricuspid valve.

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  FIGURE 2. Example of volumes measurements on MRI data for each of the three methods. Left panel: 2D‐indirect method. Top: Region of interest (ROI) of the systolic forward volume through the main pulmonary artery acquired with 2D‐phase contrast. Bottom: Functional right ventricular stroke volume (fRV SV) calculated with the systolic and diastolic difference of the functional right ventricular volume with Simpson's method on short axis steady‐state free‐precession 2D images stack. Middle panel: 4D‐indirect method. Top: ROI for the measurement of the net forward volume through the main pulmonary artery. Bottom ROI for the measurement of the inflow volume through the tricuspid valve, both acquired with 4D‐flow and with manual tracking. Right panel: 4D‐direct method: ROI for the measurement of the regurgitant volume, directly measured in the systolic regurgitant jet using 4D‐flow.

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  FIGURE 3. Correlations of the RVols for each of the three methods with total right/left volume index: Sequentially, the RVols were obtained with the 2D‐indirect method (Top left), with the 4D‐indirect method (Top right), with the 4D‐direct method (Bottom left), and with the mean of the three methods (Bottom right).

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  FIGURE 4. Bland–Altman and correlation plots between RVols obtained with each of the three methods and the mean of the three methods. Left panel: 2D‐indirect method versus mean of the three methods. Top (A): Bland–Altman plot, Bottom (B): Correlation plot. Middle panel: 4D‐indirect method versus mean of the three methods. Top (C): Bland–Altman plot, Bottom (D): Correlation plot. Right panel: 4D‐direct method versus mean of the three methods. Top (E): Bland–Altman plot, Bottom (F): Correlation plot.