Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2026
Comparison of free-running whole-heart five-dimensional and four-dimensional flow imaging to standard two-dimensional flow in patients with congenital heart disease.
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Dirbach Fabienne, Tenisch Estelle, Prša Milan, Roy Christopher W, Fässler Sara, Garelli Paolo, Rodrigues David, Falcão Mariana B L, Markl Michael, Stuber Matthias, Schwitter Jürg, Rutz Tobias
Аннотация
BACKGROUND: Flow quantification by cardiovascular magnetic resonance (CMR) is essential for diagnosis-making and follow-up in patients with congenital heart disease (CHD). Standard two-dimensional phase-contrast (2D flow) sequences require, however, precise image plane prescription, resulting in long exam times. Free-breathing three-dimensional (3D) whole-heart flow sequences (four-dimensional [4D] flow) offer faster acquisition but require respiratory navigation, rendering exam duration unpredictable. Free-running radial, fully self-gated, respiratory and cardiac motion-resolved five-dimensional (5D) flow promises ease of use and stable scan duration. This study compared net flow volumes (NFV) between 2D, 4D, and 5D flow and maximum peak velocity (Vmax) to transthoracic echocardiography (TTE).
METHODS: CHD patients were scanned on a 1.5T scanner. 2D flow was performed in the ascending (AAo), descending aorta, main (MPA), right, and left pulmonary arteries, superior vena cava, and pulmonary veins. By an in-house prototype whole-heart free-running 3D radial phase-contrast CMR sequence, end-expiratory 5D flow images were obtained. Finally, 4D flow data were collected. 3D vessel segmentation was performed for 4D and 5D flow datasets. NFV were compared between 2D, 4D, and 5D flow and Vmax to TTE.
RESULTS: Fifty-nine CHD patients (median age 28, interquartile range 17.5, 42% (25/59) women) with right- and/or left-sided CHD were included. Scan duration did not differ significantly between methods. 4D and 5D flow underestimated NFV relative to 2D flow by 4-17 mL per beat which was less prominent for 5D flow and larger vessels. Internal agreement was best for 4D flow, followed by 5D flow, while 2D flow showed the largest variability: MPA vs AAo (bias mL, 95% limits of agreement): 2D flow: -4.84 (-34.18, 24.5), 4D flow -0.84 (-17.85, 16.18), and 5D flow -6.4 (-28.53, 15.73). 2D and 4D but not 5D flow underestimated Vmax compared to TTE: AAo: TTE 120 ± 46; 2D 108 ± 36; 4D 107 ± 36; 5D 115 ± 40 cm/s; p < 0.03 TTE vs 2D and 4D flow; p = 0.253 TTE vs 5D flow.
CONCLUSION: 4D and 5D flow provided measurements comparable to 2D flow. Despite systematic underestimation of NFV, internal agreement of whole-heart methods was superior, while scan time did not increase significantly. 5D flow yielded the most accurate Vmax compared to TTE, supporting its potential for comprehensive non-invasive hemodynamic evaluation.
METHODS: CHD patients were scanned on a 1.5T scanner. 2D flow was performed in the ascending (AAo), descending aorta, main (MPA), right, and left pulmonary arteries, superior vena cava, and pulmonary veins. By an in-house prototype whole-heart free-running 3D radial phase-contrast CMR sequence, end-expiratory 5D flow images were obtained. Finally, 4D flow data were collected. 3D vessel segmentation was performed for 4D and 5D flow datasets. NFV were compared between 2D, 4D, and 5D flow and Vmax to TTE.
RESULTS: Fifty-nine CHD patients (median age 28, interquartile range 17.5, 42% (25/59) women) with right- and/or left-sided CHD were included. Scan duration did not differ significantly between methods. 4D and 5D flow underestimated NFV relative to 2D flow by 4-17 mL per beat which was less prominent for 5D flow and larger vessels. Internal agreement was best for 4D flow, followed by 5D flow, while 2D flow showed the largest variability: MPA vs AAo (bias mL, 95% limits of agreement): 2D flow: -4.84 (-34.18, 24.5), 4D flow -0.84 (-17.85, 16.18), and 5D flow -6.4 (-28.53, 15.73). 2D and 4D but not 5D flow underestimated Vmax compared to TTE: AAo: TTE 120 ± 46; 2D 108 ± 36; 4D 107 ± 36; 5D 115 ± 40 cm/s; p < 0.03 TTE vs 2D and 4D flow; p = 0.253 TTE vs 5D flow.
CONCLUSION: 4D and 5D flow provided measurements comparable to 2D flow. Despite systematic underestimation of NFV, internal agreement of whole-heart methods was superior, while scan time did not increase significantly. 5D flow yielded the most accurate Vmax compared to TTE, supporting its potential for comprehensive non-invasive hemodynamic evaluation.