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Magnetic Resonance Materials in Physics, Biology and Medicine

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Open Access 01-04-2019 | Research Article

Evaluation of atrial septal defects with 4D flow MRI—multilevel and inter-reader reproducibility for quantification of shunt severity

Authors: Raluca G. Chelu, Michael Horowitz, Dominica Sucha, Isabella Kardys, Delphine Ingremeau, Shreyas Vasanawala, Koen Nieman, Jean-Francois Paul, Albert Hsiao

Published in: Magnetic Resonance Materials in Physics, Biology and Medicine | Issue 2/2019

Abstract

Purpose

With the hypothesis that 4D flow can be used in evaluation of cardiac shunts, we seek to evaluate the multilevel and interreader reproducibility of measurements of the blood flow, shunt fraction and shunt volume in patients with atrial septum defect (ASD) in practice at multiple clinical sites.

Materials and methods

Four-dimensional flow MRI examinations were performed at four institutions across Europe and the US. Twenty-nine patients (mean age, 43 years; 11 male) were included in the study. Flow measurements were performed at three levels (valve, main artery and periphery) in both the pulmonary and systemic circulation by two independent readers and compared against stroke volumes from 4D flow anatomic data. Further, the shunt ratio (Q_p/Q_s) was calculated. Additionally, shunt volume was quantified at the atrial level by tracking the atrial septum.

Results

Measurements of the pulmonary blood flow at multiple levels correlate well whether measuring at the valve, main pulmonary artery or branch pulmonary arteries (r = 0.885–0.886). Measurements of the systemic blood flow show excellent correlation, whether measuring at the valve, ascending aorta or sum of flow from the superior vena cava (SVC) and descending aorta (r = 0.974–0.991). Intraclass agreement between the two observers for the flow measurements varies between 0.96 and 0.99. Compared with stroke volume, pulmonic flow is underestimated with 0.26 l/min at the main pulmonary artery level, and systemic flow is overestimated with 0.16 l/min at the ascending aorta level. Direct measurements of ASD flow are feasible in 20 of 29 (69%) patients.

Conclusion

Blood flow and shunt quantification measured at multiple levels and performed by different readers are reproducible and consistent with 4D flow MRI.

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Title: Evaluation of atrial septal defects with 4D flow MRI—multilevel and inter-reader reproducibility for quantification of shunt severity
Authors: Raluca G. Chelu
Michael Horowitz
Dominica Sucha
Isabella Kardys
Delphine Ingremeau
Shreyas Vasanawala
Koen Nieman
Jean-Francois Paul
Albert Hsiao
Publication date: 01-04-2019
Publisher: Springer International Publishing
Published in: Magnetic Resonance Materials in Physics, Biology and Medicine / Issue 2/2019
Print ISSN: 0968-5243
Electronic ISSN: 1352-8661
DOI: https://doi.org/10.1007/s10334-018-0702-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluation of atrial septal defects with 4D flow MRI—multilevel and inter-reader reproducibility for quantification of shunt severity

Abstract

Purpose

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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