Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2026
4D Flow Acquisition Parameters as Technical Correlates of Hemodynamic Measurements: An Analysis of the multicenter Tetralogy of Fallot Registry of 4D flow Energetics and Kinetics (TREK).
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Loke Yue-Hin, Lee Marc, O'Hara Ryan, Muegge Wiebke, Drews Katharina, Gonzalez Bryan, Axt-Fliedner Roland, Klein Jared, Friesen Richard, Dove Matthew, Ta Hieu, Kochav Jonathan, Goyal Anmol, Schoeneberg Laura, Christopher Adam, Olivieri Laura, Krishnamurthy Rajesh, Balaras Elias, d'Udekem Yves, Sotelo Julio, Taylor Michael, Fricke Stanley, Bilionis Ilias, Meyers Brett A, Capuano Francesco
Аннотация
BACKGROUND: Advanced 4D flow cardiovascular magnetic resonance (CMR) biomarkers such as kinetic energy (KE), vorticity (ω), and viscous energy loss (VEL) are increasingly used to characterize abnormal flow in repaired tetralogy of Fallot (rTOF), but their sensitivity to acquisition parameters including magnet vendor, sequence and signal quality has not been defined. We sought to evaluate the real-world variability in 4D flow sequences and technical correlates to 4D flow measurements of the aorta (Ao) and right ventricle, leveraging the multicenter Tetralogy of Fallot 4D flow Registry of Energetics and Kinetics (TREK).
METHODS: This was a multicenter observational analysis of clinically acquired 4D flow CMR processed at a core laboratory. The technical analysis focused on systolic Ao and diastolic RV hemodynamic measurements of KE, ω and VEL. Time-resolved hemodynamic curves were summarized and compared across sequence/reconstruction type, contrast agents and sequence parameters. Interobserver variability was assessed with Bland-Altman analysis and intraclass correlation coefficients. Apparent signal-to-noise ratio (aSNR), apparent velocity-to-noise ratio (aVNR) and presence of velocity aliasing were also measured. Multivariable linear/logistic regression was used to identify acquisition parameters associated with aSNR, aVNR and aliasing. Multivariable linear regression models were constructed to evaluate associations of aSNR, aVNR, and aliasing with KE, ω, and VEL after adjustment for clinical covariates.
RESULTS: The cohort included 345 datasets (295 rTOF studies and 50 controls). Sequence/reconstruction type, field strength, voxel volume, temporal resolution, and VENC were associated with aSNR and aVNR in multivariable models. Aliasing was associated with lower VENC. ω and VEL varied substantially across sequence/reconstruction type and contrast groups, whereas KE was comparatively more stable. In multivariable models, lower aSNR was associated with higher measured hemodynamic values after adjustment for clinical covariates, with stronger associations for ω and VEL rather than KE.
CONCLUSIONS: In a real-world multicenter 4D flow CMR registry, measured advanced hemodynamic biomarkers were associated with acquisition/reconstruction characteristics, apparent image quality, and residual aliasing. 4D Flow harmonization efforts should therefore extend beyond vendor types alone and explicitly account for aSNR, aVNR, and aliasing when interpreting derivative-based 4D flow measurements.
METHODS: This was a multicenter observational analysis of clinically acquired 4D flow CMR processed at a core laboratory. The technical analysis focused on systolic Ao and diastolic RV hemodynamic measurements of KE, ω and VEL. Time-resolved hemodynamic curves were summarized and compared across sequence/reconstruction type, contrast agents and sequence parameters. Interobserver variability was assessed with Bland-Altman analysis and intraclass correlation coefficients. Apparent signal-to-noise ratio (aSNR), apparent velocity-to-noise ratio (aVNR) and presence of velocity aliasing were also measured. Multivariable linear/logistic regression was used to identify acquisition parameters associated with aSNR, aVNR and aliasing. Multivariable linear regression models were constructed to evaluate associations of aSNR, aVNR, and aliasing with KE, ω, and VEL after adjustment for clinical covariates.
RESULTS: The cohort included 345 datasets (295 rTOF studies and 50 controls). Sequence/reconstruction type, field strength, voxel volume, temporal resolution, and VENC were associated with aSNR and aVNR in multivariable models. Aliasing was associated with lower VENC. ω and VEL varied substantially across sequence/reconstruction type and contrast groups, whereas KE was comparatively more stable. In multivariable models, lower aSNR was associated with higher measured hemodynamic values after adjustment for clinical covariates, with stronger associations for ω and VEL rather than KE.
CONCLUSIONS: In a real-world multicenter 4D flow CMR registry, measured advanced hemodynamic biomarkers were associated with acquisition/reconstruction characteristics, apparent image quality, and residual aliasing. 4D Flow harmonization efforts should therefore extend beyond vendor types alone and explicitly account for aSNR, aVNR, and aliasing when interpreting derivative-based 4D flow measurements.