Reduced scan time and superior image quality with 3D flow MRI compared to 4D flow MRI for hemodynamic evaluation of the Fontan pathway

Friso M Rijnberg, Hans C van Assen, Joe F Juffermans, Lucia J M Kroft, Pieter J van den Boogaard, Patrick J H de Koning, Mark G Hazekamp, Séline F S van der Woude, Evangeline G Warmerdam, Tim Leiner, Heynric B Grotenhuis, Jelle J Goeman, Hildo J Lamb, Arno A W Roest, Jos J M Westenberg

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Long scan times prohibit a widespread clinical applicability of 4D flow MRI in Fontan patients. As pulsatility in the Fontan pathway is minimal during the cardiac cycle, acquiring non-ECG gated 3D flow MRI may result in a reduction of scan time while accurately obtaining time-averaged clinical parameters in comparison with 2D and 4D flow MRI. Thirty-two Fontan patients prospectively underwent 2D (reference), 3D and 4D flow MRI of the Fontan pathway. Multiple clinical parameters were assessed from time-averaged flow rates, including the right-to-left pulmonary flow distribution (main endpoint) and systemic-to-pulmonary collateral flow (SPCF). A ten-fold reduction in scan time was achieved [4D flow 15.9 min (SD 2.7 min) and 3D flow 1.6 min (SD 7.8 s), p < 0.001] with a superior signal-to-noise ratio [mean ratio of SNRs 1.7 (0.8), p < 0.001] and vessel sharpness [mean ratio 1.2 (0.4), p = 0.01] with 3D flow. Compared to 2D flow, good-excellent agreement was shown for mean flow rates (ICC 0.82-0.96) and right-to-left pulmonary flow distribution (ICC 0.97). SPCF derived from 3D flow showed good agreement with that from 4D flow (ICC 0.86). 3D flow MRI allows for obtaining time-averaged flow rates and derived clinical parameters in the Fontan pathway with good-excellent agreement with 2D and 4D flow, but with a tenfold reduction in scan time and significantly improved image quality compared to 4D flow.

Original languageEnglish
Article number6507
Pages (from-to)1-10
JournalScientific Reports
Issue number1
Publication statusPublished - 22 Mar 2021


  • Adolescent
  • Child
  • Female
  • Fontan Procedure/adverse effects
  • Hemodynamics
  • Humans
  • Imaging, Three-Dimensional/methods
  • Magnetic Resonance Imaging/methods
  • Male
  • Postoperative Complications/diagnostic imaging
  • Signal-To-Noise Ratio
  • Young Adult


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