Search

Objectives: Two-dimensional (2D) through-plane phase-contrast (PC) cine flow imaging assesses shunts and valve regurgitations in paediatric CMR and is considered the reference standard for Clinical quantification of blood Flow (COF). However, longer breath-holds (BH) can reduce compliance with possibly large respiratory manoeuvres altering flow. We hypothesize that reduced BH time by application of CS (Short BH quantification of Flow) (SBOF) retains accuracy while enabling faster, potentially more reliable flows. We investigate the variance between COF and SBOF cine flows., Methods: Main pulmonary artery (MPA) and sinotubular junction (STJ) planes were acquired at 1.5 T in paediatric patients by COF and SBOF., Results: 21 patients (mean age 13.9, 10-17y) were enrolled. The BH times were COF mean 11.7 s (range 8.4-20.9 s) vs SBOF mean 6.5 s (min 3.6-9.1 s). The differences and 95% CI between the COF and SBOF flows were LVSV -1.43 ± 13.6(ml/beat), LVCO 0.16 ± 1.35(l/min) and RVSV 2.95 ± 12.3(ml/beat), RVCO 0.27 ± 0.96(l/min), QP/QS were SV 0.04 ± 0.19, CO 0.02 ± 0.23. Variability between COF and SBOF did not exceed intrasession variation of COF., Conclusion: SBOF reduces breath-hold duration to 56% of COF. RV flow by SBOF was biased compared to COF. The variation (95% CI) between COF and SBOF was similar to the COF intrasession test-retest 95% CI., (© 2023. Crown.)

Background: Measurement of ventricular volumes and function using MRI is an important tool in pediatric congenital heart disease. However, normal values for children are sparce and analysis methods are inconsistent., Purpose: To propose biventricular reference values in children for two MRI postprocessing (contouring) techniques., Study Type: Retrospective., Subjects: A total of 154 children from two institutions (13.9 ± 2.8 years; 101 male) that were referred for a clinical MRI study., Field Strength/sequence: 1.5 T; balanced steady-state free precession (bSSFP) sequence., Assessment: Left ventricular (LV) and right ventricular (RV) end-diastolic and end-systolic volumes (LVEDV, LVESV, RVEDV, RVESV) and end-diastolic and end-systolic myocardial mass (LVEDMM, LVESMM, RVEDMM, RVESMM) were measured from short-axis images using two contouring techniques: 1) papillary muscles, trabeculations and the moderator band were included in the ventricular blood volume and excluded from the myocardial mass, 2) papillary muscles, trabeculations and the moderator band were excluded from the ventricular volume and included in the ventricular mass., Statistical Tests: Univariable and multivariable linear regression models were used to evaluate relationships between sex, weight, height, body surface area (BSA) and age and volumetric results. Reference graphs and tables were created with the LMS-method. Contouring techniques were compared by intraclass correlation, regression analysis and Bland-Altman plots. A P value < 0.05 was considered statistically significant., Results: Height and BSA were significantly associated with LVESV (method 1) and with LVEDV and RVEDV (method 2). LVESV (method 2), RVESV (both methods), RVEDV (method 1), and LVEDMM and RVEDMM (both methods), showed significant associations with height and weight. LVSV and RVSV (both methods) were significantly associated with BSA and weight. RVESV (method 1) was significantly associated with age. Gender showed significant associations for all parameters., Data Conclusion: The proposed pediatric reference values can be used in the diagnosis and follow-up of congenital or acquired heart disease and for research purposes., Evidence Level: 3 TECHNICAL EFFICACY: Stage 2., (© 2022 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Background: Measurement of atrial volumes by MRI is becoming increasingly important in pediatric cardiac disorders. However, MRI normal values for atrial volumes in children are lacking., Purpose: To establish pediatric reference values for atrial volumes., Study Type: Retrospective., Subjects: A total of 155 healthy children from two large institutions (103 male, age 13.9 ± 2.8 years, range 4-18 years)., Field Strength/sequence: A 1.5 T; balanced steady-state free precession (bSSFP) sequence., Assessment: The monoplane and biplane area-length methods were used to measure minimal and maximal left and right atrial volumes (LA min , LA max , RA min , and RA max ) from four-chamber (4ch) and two-chamber (2ch) MR cine images. Centile charts and tables for atrial volumes were created., Statistical Tests: Descriptive statistics, lambda-mu-sigma (LMS)-method of Cole and Green, univariable and multivariable linear regression models. A P value < 0.05 was considered to be statistically significant., Results: In the multivariable linear model, body surface area was significantly associated with all atrial volumes and sex was significantly associated with RA volumes, LA volumes measured in the 2ch-view as well as biplane LA max. Average atrial volumes measured: monoplane 4ch: LA min 13.1 ± 4.8 mL/m 2 , LA max 33.4 ± 8.8 mL/m 2 , RA min 18.5 ± 6.8 mL/m 2 , RA max 33.2 ± 9.6 mL/m 2 ; monoplane 2ch: LA min 12.7 ± 4.9 mL/m 2 , LA max 30.5 ± 9.5 mL/m 2 ; biplane: LA min 12.3 ± 4.5 mL/m 2 , LA max 30.9 ± 8.7 mL/m 2 ., Data Conclusion: Pediatric MRI reference values for atrial volumes have been provided., Technical Efficacy: 2 EVIDENCE LEVEL: 4., (© 2022 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Objectives: Two-dimensional (2D) through-plane phase-contrast (PC) cine flow imaging assesses shunts and valve regurgitations in paediatric CMR and is considered the reference standard for Clinical quantification of blood Flow (COF). However, longer breath-holds (BH) can reduce compliance with possibly large respiratory manoeuvres altering flow. We hypothesize that reduced BH time by application of CS (Short BH quantification of Flow) (SBOF) retains accuracy while enabling faster, potentially more reliable flows. We investigate the variance between COF and SBOF cine flows. Methods: Main pulmonary artery (MPA) and sinotubular junction (STJ) planes were acquired at 1.5 T in paediatric patients by COF and SBOF. Results: 21 patients (mean age 13.9, 10–17y) were enrolled. The BH times were COF mean 11.7 s (range 8.4–20.9 s) vs SBOF mean 6.5 s (min 3.6–9.1 s). The differences and 95% CI between the COF and SBOF flows were LVSV -1.43 ± 13.6(ml/beat), LVCO 0.16 ± 1.35(l/min) and RVSV 2.95 ± 12.3(ml/beat), RVCO 0.27 ± 0.96(l/min), QP/QS were SV 0.04 ± 0.19, CO 0.02 ± 0.23. Variability between COF and SBOF did not exceed intrasession variation of COF. Conclusion: SBOF reduces breath-hold duration to 56% of COF. RV flow by SBOF was biased compared to COF. The variation (95% CI) between COF and SBOF was similar to the COF intrasession test–retest 95% CI. [ABSTRACT FROM AUTHOR]

Aims Cardiovascular magnetic resonance (CMR) is valuable for the detection of cardiac involvement in neuromuscular diseases (NMDs). We explored the value of 2D- and 3D-left ventricular (LV) myocardial strain analysis using feature-tracking (FT)-CMR to detect subclinical cardiac involvement in NMD. Methods and results The study included retrospective analysis of 111 patients with NMD; mitochondrial cytopathies (n = 14), Friedreich's ataxia (FA, n = 27), myotonic dystrophy (n = 27), Becker/Duchenne's muscular dystrophy (BMD/DMD, n = 15), Duchenne's carriers (n = 6), or other (n = 22) and 57 age- and sex-matched healthy volunteers. Biventricular volumes, myocardial late gadolinium enhancement (LGE), and LV myocardial deformation were assessed by FT-CMR, including 2D and 3D global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), and torsion. Compared with the healthy volunteers, patients with NMD had impaired 2D-GCS (P < 0.001) and 2D-GRS (in the short-axis, P < 0.001), but no significant differences in 2D-GRS long-axis (P = 0.101), 2D-GLS (P = 0.069), or torsion (P = 0.122). 3D-GRS, 3D-GCS, and 3D-GLS values were all significantly different to the control group (P < 0.0001 for all). Especially, even NMD patients without overt cardiac involvement (i.e. LV dilation/hypertrophy, reduced LVEF, or LGE presence) had significantly impaired 3D-GRS, GCS, and GLS vs. the control group (P < 0.0001). 3D-GRS and GCS values were significantly associated with the LGE presence and pattern, being most impaired in patients with transmural LGE. Conclusions 3D-FT CMR detects subclinical cardiac muscle disease in patients with NMD even before the development of replacement fibrosis or ventricular remodelling which may be a useful imaging biomarker for early detection of cardiac involvement. [ABSTRACT FROM AUTHOR]

Background: Myocardial deformation can be assessed from routine cardiac magnetic resonance (MR) images using two‐dimensional feature tracking (2D‐FT). Although reference values are essential for implementation of strain imaging in clinical practice, data for the healthy pediatric age group are limited. Purpose To provide pediatric MR reference values for strain and strain rate for all four heart chambers. Study Type: Retrospective. Subjects: One hundred and fifty‐seven healthy children from two institutions (102 male, age 4.7–18 years). Field Strength/Sequence: 1.5 T; balanced steady‐state free precession sequence. Assessment Left ventricular (LV) global and regional longitudinal, circumferential, and radial strain and strain rate as well as right ventricular (RV) and atrial global and regional longitudinal strain and strain rate were measured in two‐, three‐, and four‐chamber views and the short axis stack. The relationships between strain parameters and age, height, weight, and gender were investigated. Age‐ and height‐specific centile curves and tables were created for LV strain and strain rate. For all other global strain parameters, the mean was calculated as a reference. Statistical Tests: Lambda‐mu‐sigma (LMS)‐method of Cole and Green, univariable, and multivariable linear regression models. A P value <0.05 was considered to be statistically significant. Results: Age, height and weight had a significant influence on LV global strain values. These parameters also showed an influence on RV strain but only in boys (girls P = 0.12) and none of the variables had a significant influence on atrial strain (P = 0.19–0.49). Gender differences were only found for RV strain values. Data Conclusion: Pediatric potential reference values for myocardial deformation parameters of both ventricles and atria are provided. The values may serve as a reference in future studies and clinical practice. Level of Evidence: 3 Technical Efficacy: Stage 5 [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that ventricular and atrial function are different between patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) and healthy controls.Methods: 103 consecutive patients with TGA (median age: 16.7 years, 4.3-39.6 years, 71.8% male) were compared with 77 controls (median age: 15.4 years, 6.3-43.2 years, 66.2% male). Biventricular and biatrial function were assessed using standard cardiovascular magnetic resonance (CMR) techniques and feature tracking. Group comparison was performed with conventional non-parametrical statistics and machine learning methods to find the variables most discriminative between patients and controls. These variables were used to build a multivariable logistic regression model to assess the case-control status.Results: Markers of left and right ventricular function (LV; RV) (ejection fraction, MAPSE, TAPSE, LV long-axis strain) as well as LV global longitudinal (-20.7 (-24.1; -17.9) vs -23.7 (-26.1; -21.6), p<0.001), circumferential (-29.4 (-32.2; -26.5) vs -30.5 (-33.6; 29), p=0.001) and atrial longitudinal strain (left atrium (LA): 23.3 (18.6; 28.8) vs 36.7 (30.7; 44), p<0001; right atrium: 21.7 (18.2; 27.8) vs 34.9 (26.9; 40.3), p<0.001) were reduced in patients compared with controls using non-parametrical testing. The logistic regression model including the most discriminative variables from univariate and machine learning analysis demonstrated significant differences between patients and controls only for TAPSE and LA global longitudinal strain.Conclusions: Biventricular and biatrial function are largely preserved after ASO for TGA. Using a comprehensive CMR protocol along with statistical machine learning methods and a regression approach, only RV longitudinal function and LA function are significantly impaired. [ABSTRACT FROM AUTHOR]

BACKGROUND: Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance. METHODS: We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases. RESULTS: A total of 215 patients (median age 46 years; range, 6-83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively; P=0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57-157] mL/m2, P=0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure. CONCLUSIONS: This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular magnetic resonance (CMR) derived fractal analysis of the left ventricle (LV) has been shown in adults to be a useful quantitative measure of trabeculation with high reproducibility and accuracy for the diagnosis of LV non-compaction (LVNC). The aim of this study was to investigate the utility and feasibility of fractal analysis in children. Methods: Eighty-four subjects underwent CMR: (1) 28 patients with LVNC (as defined by the Petersen criteria with NC/C ratio ≥ 2.3); (2) 28 patients referred by clinicians for assessment of hyper-trabeculation and found not to qualify as LVNC (NC/C ≥ 1.8 and < 2.3); (3) 28 controls. The fractal scores for each group were presented as global and maximal fractal dimension as well as for 3 segments of the LV: basal, mid, and apical. Statistical comparison of the fractal scores between the 3 groups was performed. Results: Global fractal dimension (FD) was higher in the LVNC group than in the hyper-trabeculated group: 1.345 (SEM 0.053) vs 1.252 (SEM 0.034), p < 0.001 and higher in hyper-trabeculated group than in controls: 1.252 (SEM 0.034) vs 1.158 (SEM 0.038), p < 0.001. The highest maximum FD was in the apical portion of the LV in the LVNC group, (1.467; SEM 0.035) whereas it was in the mid ventricle in the hyper-trabeculated (1.327; SEM 0.025) and healthy groups (1.251; SEM 0.042). Fractal analysis showed lower intra- and interobserver variability than the Petersen and Jacquier methods. Conclusions: It is technically feasible to perform fractal analysis in children using CMR and that it is quick, accurate and reproducible. Fractal scoring accurately distinguishes between LVNC, hyper-trabeculation and healthy controls as defined by the Petersen criteria. [ABSTRACT FROM AUTHOR]

Background: Pediatric patients are becoming increasingly referred for cardiovascular magnetic resonance (CMR). Measurement of ventricular wall thickness is typically part of the assessment and can be of diagnostic importance, e.g. in arterial hypertension. However, normal values for left ventricular (LV) and right ventricular (RV) wall thickness in pediatric patients are lacking. The aim of this study was to establish pediatric centile charts for segmental LV and RV myocardial thickness in a retrospective multicenter CMR study. Methods: CMR was performed in 161 healthy children and adolescents with an age range between 6 and 18 years from two centers in the UK and Germany as well as from a previously published CMR project of the German Competence Network for Congenital Heart Defects. LV myocardial thickness of 16 segments was measured on the short axis stack using the American Heart Association segmentation model. In addition, the thickness of the RV inferior and anterior free wall as well as biventricular mass was measured. Results: The mean age (standard deviation) of the subjects was 13.6 (2.9) years, 64 (39.7%) were female. Myocardial thickness of the basal septum (basal antero- and inferoseptal wall) was 5.2 (1.1) mm, and the basal lateral wall (basal antero- and inferolateral) measured 5.1 (1.2) mm. Mid-ventricular septum (antero- and inferoseptal wall) measured 5.5 (1.2) mm, and mid-ventricular lateral wall (antero- and inferolateral wall) was 4.7 (1.2) mm. Separate centile charts for boys and girls for all myocardial segments and myocardial mass were created because gender was significantly correlated with LV myocardial thickness (p < 0.001 at basal level, p = 0.001 at midventricular level and p = 0.005 at the apex) and biventricular mass (LV, p < 0.001; RV, p < 0.001). Conclusion: We established CMR normal values of segmental myocardial thickness and biventricular mass in children and adolescents. Our data are of use for the detection of abnormal myocardial properties and can serve as a reference in future studies and clinical practice. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: Left ventricular noncompaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood. Standard diagnostic criteria are still controversial, especially in young patients. Recent studies in adults demonstrated that left ventricular (LV) twist is abnormal in LVNC, but it has not been investigated in pediatric patients to date. Our aim was to assess LV cardiac mechanics, LV twist, and the prevalence of rigid body rotation, using 2-dimensional speckle tracking echocardiography, in young patients with LVNC and LV hypertrabeculation. Methods: Forty-seven children (age range: 0–18 years) were assessed for suspected LVNC. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging at 1.5 Tesla (T). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group. Forty-seven age- and sex-matched healthy volunteers were used as controls. Results: The average LV twist was significantly reduced in LVNC compared with control and LV hypertrabeculation. Rigid body rotation was recognized in 13 (56%) children with LVNC and in 1 (4%) child with LV hypertrabeculation and a strong family history for LVNC. Multivariable analysis demonstrated that LV twist is an independent predictor of LVNC (P =0.006; coefficient=0.462). The receiver operating characteristics curve showed that LV twist had optimal predictive value to discriminate patients with LVNC (cutoff value <5.8°; sensitivity, 82%; specificity, 92%; area under the curve=0.914). Conclusions: LV twist has good predictive value in diagnosing LVNC in young patients. Our findings strongly support the routine use of 2-dimensional speckle tracking echocardiography in the evaluation of young patients with suspected LVNC. [ABSTRACT FROM AUTHOR]