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(Circulation. 2004;109:1987-1993.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Flow Volume and Shunt Quantification in Pediatric Congenital Heart Disease by Real-Time Magnetic Resonance Velocity Mapping

A Validation Study

Hermann Körperich, PhD; Jürgen Gieseke, MSc; Peter Barth, MSc; Romhild Hoogeveen, PhD; Hermann Esdorn, MD; Andreas Peterschröder, MD; Hans Meyer, MD; Philipp Beerbaum, MD

From the Clinic for Congenital Heart Disease and Institute for Magnetic Resonance Imaging (H.K., P. Barth, H.E., A.P., H.M., P. Beerbaum), Heart- and Diabetescenter Northrhine-Westfalia, Ruhr-University of Bochum, Germany, and Philips Medical Systems (J.G., R.H.), Best, The Netherlands.

Correspondence to Philipp Beerbaum, MD, Clinic for Congenital Heart Disease, Heart- and Diabetescenter Northrhine-Westfalia, Ruhr-University of Bochum, Georgstraße 11, D-32545 Bad Oeynhausen, Germany. E-mail pbeerbaum{at}hdz-nrw.de

Received November 4, 2003; revision received January 27, 2004; accepted February 4, 2004.

Background— Flow quantification in real time by phase-contrast MRI (PC-MRI) may provide unique hemodynamic information in congenital heart disease, but available techniques have important limitations. We sought to validate a novel real-time magnetic resonance flow sequence in children.

Methods and Results— In 14 pediatric patients (mean age 5.2±2.0 years) with cardiac left-to-right shunt, pulmonary (Q_p) and aortic (Q_s) flow rates were determined by nontriggered free-breathing real-time PC-MRI with single-shot echo-planar imaging combined with sensitivity encoding, which yielded 25 phase images per second at 2.7x2.7-mm in-plane resolution (field of view 30x34 cm²). Over a 9.5-second period that included 2 to 5 respiratory cycles, 16.6±2.6 subsequent stroke volumes (range 13 to 22) were acquired in each vessel. Results were compared with conventional retrospectively ECG-gated PC-MRI. Mean Q_p/Q_s by conventional PC-MRI was 1.91±0.64, and it was 1.94±0.68 (mean±SD) by real-time PC-MRI. For blood flow rate through pulmonary artery and aorta, we found differences of 2% to 3% (Bland-Altman analysis), with lower limits of agreement of –11% to –13% (mean–2 SD) and upper limits of 18% to 19% (mean+2 SD), which demonstrated good agreement between both methods. Mean difference for Q_p/Q_s was 1%, with limits of agreement ranging between –18% and 22% (mean±2 SD). High repeatability but some flow overestimation was observed in vitro (pulsatile flow phantom) with real-time PC-MRI, whereas conventional PC-MRI was accurate. Beat-to-beat stroke-volume variation was 6.1±2.3% in vivo and 3.7±0.3% in vitro.

Conclusions— Beat-to-beat quantification of pulmonary and aortic flows and hence left-to-right shunt within a few seconds is reliable by nontriggered real-time PC-MRI with echo-planar imaging and sensitivity encoding. Good spatial/temporal resolution and a large field of view may render the sequence valuable for multiple applications in congenital heart disease.

Key Words: magnetic resonance imaging • blood flow • heart defects, congenital • pediatrics • shunts

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