Validation of comprehensive CMR scan using novel isotropic 3D Cine (ESSOS) and 4D-flow for cardiac function evaluation in adult patients with congenital heart disease

Abstract Background Cardiac magnetic resonance imaging (CMR) is the gold standard for evaluating adult congenital heart disease (ACHD), but conventional protocols are time-consuming. Objective This study aimed to validate 3D cine (ESSOS) and 4D-flow MRI compared with standard 2D cine and 2D flow techniques in ACHD patients. Methods Eligible ACHD patients (≥18 years) underwent standard 2D cine and 2D flow imaging, followed by 3D cine (ESSOS) and 4D flow acquisitions using a 3.0T MRI system. Ventricular volumes, function, and flow parameters were assessed, with comparisons made using intraclass correlation coefficients (ICC) and Bland-Altman analysis. Results Eleven patients completed both advanced sequences. ESSOS showed excellent agreement with 2D cine for stroke volume (ICC = 0.964) and LV mass (ICC = 0.936), with good agreement for most volume metrics in same scan time (7.2 vs. 8.1 minutes). LVEF and RVEF showed moderate to poor agreement. 4D-flow imaging also halved acquisition time versus 2D flow (7.5 vs. 15.9 minutes) and demonstrated good to excellent agreement with 2D flow for ascending aorta (ICC = 0.844) and pulmonary artery flow (ICC = 0.959). Conclusion ESSOS and 4D-flow are accurate, time-efficient alternatives to conventional techniques, supporting their integration into CMR protocols for ACHD assessment.Intraclass Correlation Bland altman plot