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27.06.2016 | Original Article

Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

verfasst von: Kelly Jarvis, Susanne Schnell, Alex J. Barker, Julio Garcia, Ramona Lorenz, Michael Rose, Varun Chowdhary, James Carr, Joshua D. Robinson, Cynthia K. Rigsby, Michael Markl

Erschienen in: Pediatric Radiology | Ausgabe 11/2016

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Abstract

Background

Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry.

Objective

We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry.

Materials and methods

Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16 ± 4 years [mean ± standard deviation], range: 9–21 years). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle).

Results

Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78% ± 28 [9–100], IVC to LPA: 54% ± 28 [4–98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R²=0.50, P=0.02; SVC to LPA: R²=0.81, P=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values.

Conclusion

Four-dimensional flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability.

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Titel: Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI
verfasst von: Kelly Jarvis
Susanne Schnell
Alex J. Barker
Julio Garcia
Ramona Lorenz
Michael Rose
Varun Chowdhary
James Carr
Joshua D. Robinson
Cynthia K. Rigsby
Michael Markl
Publikationsdatum: 27.06.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Radiology / Ausgabe 11/2016
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-016-3654-3

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Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI