4D FLOW CMR in congenital heart disease

This thesis showed that the use of a cloud-based reconstruction applicationwith advanced eddy currents correction, integrated with interactiveimaging evaluation tools allowed for remote visualization and interpretationof 4D flow data and that was sufficient for gross visualizationof aortic valve regurgitation. Further, this thesis demonstrated that bulkflow and pulmonary regurgitation can be accurately quantified using 4Dflow imaging analyzed. Peak systolic velocity over the pulmonary valvemay be underestimated. However, the measurement of peak systolicvelocity can be optimized if measured at the level of highest velocity inthe pulmonary artery. Also correlated against invasive measurements (inan animal model), this thesis shows that aorta flow and pulmonary flowcan be accurately and simultaneously measured by 4D flow MRI.When applied in clinical practice, 4D flow has extra advantages, of beingable to visualize flow pattern, vorticity and to predict aortic growth. InASD patients it can measure shunt volume directly following the septumframe by frame. In Fontan patients in can visualize better than standardMRI the Fontan circuit and it can measure flow at multiple points alongthe Fontan circuit. We observed in our Fontan population that shunt lesionswere very common, most of the time via veno-venous collaterals.Further using advanced computations, we showed that WSS angle wasthe only independent predictor of aortic growth in BAV patients. We alsoshowed the feasibility of GLS analysis on 4D flow MRI and presented anintegrative approach in which flow and functional data are acquired inone sequence.From the technical point of view, 4D flow MRI has proved to complementthe traditional components of the standard cardiac MR exams, enablingin-depth insights into hemodynamics. At this moment it proved its addedvalue, but in most of the cases it is not able yet to replace the standardexam. This is still due to long scanning times and relatively longpost-processing times.<br/

4D FLOW CMR in congenital heart disease

This thesis showed that the use of a cloud-based reconstruction applicationwith advanced eddy currents correction, integrated with interactiveimaging evaluation tools allowed for remote visualization and interpretationof 4D flow data and that was sufficient for gross visualizationof aortic valve regurgitation. Further, this thesis demonstrated that bulkflow and pulmonary regurgitation can be accurately quantified using 4Dflow imaging analyzed. Peak systolic velocity over the pulmonary valvemay be underestimated. However, the measurement of peak systolicvelocity can be optimized if measured at the level of highest velocity inthe pulmonary artery. Also correlated against invasive measurements (inan animal model), this thesis shows that aorta flow and pulmonary flowcan be accurately and simultaneously measured by 4D flow MRI.When applied in clinical practice, 4D flow has extra advantages, of beingable to visualize flow pattern, vorticity and to predict aortic growth. InASD patients it can measure shunt volume directly following the septumframe by frame. In Fontan patients in can visualize better than standardMRI the Fontan circuit and it can measure flow at multiple points alongthe Fontan circuit. We observed in our Fontan population that shunt lesionswere very common, most of the time via veno-venous collaterals.Further using advanced computations, we showed that WSS angle wasthe only independent predictor of aortic growth in BAV patients. We alsoshowed the feasibility of GLS analysis on 4D flow MRI and presented anintegrative approach in which flow and functional data are acquired inone sequence.From the technical point of view, 4D flow MRI has proved to complementthe traditional components of the standard cardiac MR exams, enablingin-depth insights into hemodynamics. At this moment it proved its addedvalue, but in most of the cases it is not able yet to replace the standardexam. This is still due to long scanning times and relatively longpost-processing times.<br/

Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association

Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice

Review of Journal of Cardiovascular Magnetic Resonance 2014

There were 102 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2014, which is a 6 % decrease on the 109 articles published in 2013. The quality of the submissions continues to increase. The 2013 JCMR Impact Factor (which is published in June 2014) fell to 4.72 from 5.11 for 2012 (as published in June 2013). The 2013 impact factor means that the JCMR papers that were published in 2011 and 2012 were cited on average 4.72 times in 2013. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal’s impact over the last 5 years has been impressive. Our acceptance rate is <25 % and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication

Untersuchung der longitudinalen Deformation des rechten Systemventrikels bei Patienten mit hypoplastischem Linksherzsyndrom mittels 2-dimensionaler Feature Tracking Magnetresonanztomographie

Die Bestimmung der rechtsventrikulären Funktion ist für die Beurteilung des klinischen Zustandes der HLHS-Patienten und für ihre Prognose entscheidend. Neben der dazu etablierten Messung der Ejektionsfraktion konnte in echokardiographischen Studien gezeigt werden, dass auch die Bestimmung der myokardialen Deformationsparameter zur Beurteilung der rechtsventrikulären Funktion geeignet sein könnte. Das Ziel unserer Studie war deshalb die erstmalige Untersuchung der Machbarkeit des 2D-FT zur Bestimmung der myokardialen Deformationsparameter des rechten Systemventrikels an einer großen Studienpopulation von 55 HLHS-Patienten, die in unserer Klinik eine kardiale MRT Untersuchung erhalten haben. Darüber hinaus sollten Unterschiede zwischen den anatomischen Subgruppen sowie zwischen den Hemifontan- und Fontan-Patienten identifiziert werden. Zur besseren Beurteilung unserer Ergebnisse für die myokardialen Deformationsparameter erfolgte innerhalb einer Kohorte zusätzlich ein Methodenvergleich des 2D-FT zum etablierten 2D-ST aus der Echokardiographie. Abschließend sollten zur Abschätzung des klinischen Potenzials der neuen Technik mögliche Korrelationen der myokardialen Deformationsparameter mit demographischen und klinischen Parametern analysiert werden. Unserer Studie zeigte eine ausgezeichnete Durchführbarkeit des 2D-FT für den rechten Systemventrikel der HLHS-Patienten. Somit konnten umfangreiche Referenzwerte für die myokardialen Deformationsparameter der regionalen und globalen Segmente angegeben werden. In der Analyse der myokardialen Deformationsparameter hinsichtlich der anatomischen Subgruppen wurde für die HLHS Patienten mit einem rudimentären linken Ventrikel im septalen Segment ein reduzierter LS festgestellt. Zwischen den Hemifontan- und Fontan Patienten zeigten sich keine signifikanten Unterschiede der Deformationsparameter. Im Methodenvergleich zwischen dem 2D-FT und 2D-ST lag insbesondere für den regionalen und globalen LS eine gute Vergleichbarkeit der Ergebnisse vor. Die Deformationsparameter GLS und GLSR zeigten im 2D FT eine signifikante Korrelation mit der Ejektionsfraktion. Zusammenfassend kann festgestellt werden, dass das 2D-FT zur Beurteilung der myokardialen Deformationsparameter des rechten Systemventrikels bei HLHS-Patienten erfolgreich angewendet werden kann. Das klinische Potenzial dieses neuen Ansatzes, insbesondere zur erweiterten Beurteilung der rechtsventrikulären Funktion, sieht in unserer Studie für die HLHS-Patienten vielversprechend aus. Inwieweit sich das 2D-FT als eine zuverlässige klinische Methode zukünftig etablieren kann, werden weitere Langzeitstudien zeigen müssen