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4D cardiac magnetic resonance flow imaging in neonates - feasibility and reproducibility

Session Rapid Fire Abstract 2: how CMR can help in congenital heart disease

Speaker Anne Vejlstrup

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Flow Imaging
  • Session type : Rapid Fire Abstracts

Authors : A Vejlstrup (Copenhagen,DK), K Iversen (Herlev,DK), K Juul (Copenhagen,DK), H Bundgaard (Copenhagen,DK), J Kromann (Copenhagen,DK), N Vejlstrup (Copenhagen,DK)

A Vejlstrup1 , K Iversen2 , K Juul1 , H Bundgaard3 , J Kromann4 , N Vejlstrup1 , 1Rigshospitalet - Copenhagen University Hospital, Department of Pediatric Cardiology - Copenhagen - Denmark , 2Herlev Hospital, Department of Cardiology - Herlev - Denmark , 3Rigshospitalet - Copenhagen University Hospital, Department of Cardiology - Copenhagen - Denmark , 4Rigshospitalet - Copenhagen University Hospital, Department of Radiology - Copenhagen - Denmark ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii202

Background:  New free-breathing 4D flow MRI techniques (ViosWorks, GE-Healthcare) have made it possible to scan neonates without sedation. The method has great potentials in children and neonates but studies of feasibility and reproducibility of the measurements are lacking.

Purpose: We aimed to investigate the feasibility and inter-observer reproducibility of 4D flow MRI analysis in free breathing neonates without sedation and contrast using Arterys cloud solution and software. We also wanted to study the success rate of scanning unsedated neonates.

Method:  From the Baby Heart study (CBH), where 25.000 newborns had an echocardiographic examination within the first 31 days, a cohort of 100 neonates accepted to participate in the CMRI protocol. The neonates were scanned on a 1.5 Tesla Optima MR450w (GE-Healthcare) with ViosWorks. Three independent observers performed a flow analysis of 42 normal scans using Arterys cloud solution. Coefficient of variation (CV), inter-observer correlation coefficients (ICC) and a generalization of the Bland-Altman plot to multiple observers were assessed.

Results: It was possible to perform a useful 4D flow acquisition without sedation in 70 of the 100 neonates (70%), contrary it was not possible in the last 30% due to restless newborns. Analyses of flow in the aortic arch and pulmonary circulation could be performed in less than 10 min. 
Pulmonary artery blood flow (Qp) was in average 14% higher than the aortic flow (Qs), probably reflecting flow through an open foramen ovale. 
The CV for 4D CMR flow were: 8.8% for flow in the ascending aorta and 9.4% for flow in the main pulmonary artery. The single measure ICC estimate for the ascending aorta flow was 0.86 95% CI(0.67-0.94) and for the main pulmonary artery 0.82 95% CI(0.48-0.92).

Conclusion:  4D flow CMRI without sedation using ViosWorks and Artery’s software is feasible (70% success rate), quick and with a good inter-observer reproducibility.

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