Key result
3D flow MRI provided equivalent right-to-left pulmonary flow distribution measurements compared to 2D flow (mean absolute difference 2.6%) and reduced scan time ten-fold compared to 4D flow (1.6 vs 15.9 minutes) in Fontan patients.
Why the study?
Long scan times limit the clinical use of 4D flow MRI in Fontan patients, while non-ECG gated 3D flow MRI could reduce scan time and reliably obtain time-averaged parameters.
Does 3D flow MRI improve scan time and image quality while maintaining accuracy compared to 2D and 4D flow MRI in Fontan patients?
Observational (n=32)
Does 3D flow MRI improve scan time and image quality while maintaining accuracy compared to 2D and 4D flow MRI in Fontan patients?
Mean Difference: 2.6 (95% CI 1.8–3.3)
Absolute Event Rate: 56.5% vs 55.5%
p-value: p=<0.001
Non-ECG gated 3D flow MRI provides accurate hemodynamic evaluation of the Fontan pathway with a ten-fold reduction in scan time compared to 4D flow MRI, facilitating broader clinical applicability.
Supports efficient Fontan flow assessment; extends 2D/4D comparisons but leaves open prospective validation.
Long scan times prohibit a widespread clinical applicability of 4D flow MRI in Fontan patients. As pulsatility in the Fontan pathway is minimal during the cardiac cycle, acquiring non-ECG gated 3D flow MRI may result in a reduction of scan time while accurately obtaining time-averaged clinical parameters in comparison with 2D and 4D flow MRI. Thirty-two Fontan patients prospectively underwent 2D (reference), 3D and 4D flow MRI of the Fontan pathway. Multiple clinical parameters were assessed from time-averaged flow rates, including the right-to-left pulmonary flow distribution (main endpoint) and systemic-to-pulmonary collateral flow (SPCF). A ten-fold reduction in scan time was achieved [4D flow 15.9 min (SD 2.7 min) and 3D flow 1.6 min (SD 7.8 s), p < 0.001] with a superior signal-to-noise ratio [mean ratio of SNRs 1.7 (0.8), p < 0.001] and vessel sharpness [mean ratio 1.2 (0.4), p = 0.01] with 3D flow. Compared to 2D flow, good-excellent agreement was shown for mean flow rates (ICC 0.82-0.96) and right-to-left pulmonary flow distribution (ICC 0.97). SPCF derived from 3D flow showed good agreement with that from 4D flow (ICC 0.86). 3D flow MRI allows for obtaining time-averaged flow rates and derived clinical parameters in the Fontan pathway with good-excellent agreement with 2D and 4D flow, but with a tenfold reduction in scan time and significantly improved image quality compared to 4D flow.
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Rijnberg et al. (2021) conducted an observational in Fontan circulation (n=32). 3D flow MRI vs. 2D and 4D flow MRI was evaluated on Mean absolute difference in right-to-left pulmonary flow distribution (2D vs 3D flow) (MD 2.6%, 95% CI 1.8-3.3, p=<0.001). 3D flow MRI provided equivalent right-to-left pulmonary flow distribution measurements compared to 2D flow (mean absolute difference 2.6%) and reduced scan time ten-fold compared to 4D flow (1.6 vs 15.9 minutes) in Fontan patients.
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