Table 1 Open in new tab Advantages,...

Table 1

Advantages, disadvantages, availability, and applications of novel technologies in CHD

Technology	Advantages	Disadvantages	Availability	Applications in CHD
4D Flow	Planning the acquisition volume is easy Multi-dimensional analysis of blood flow Quantification of multiple haemodynamic markers Commercial analysis software is widely available	Can be time-consuming	Widely available	Can be applied to every patient with CHD for blood flow assessment (e.g. stroke volumes, regurgitant volumes, Qp/Qs)
Mapping techniques	Easy to acquire Short acquisition times Provides additional information about myocardial tissue characteristics (diffuse changes) Commercial analysis software is widely available	Reference values for every MR machine need to be established Possible side effects when contrast agent is given for ECV calculation	Widely available	Can be applied to every patient with CHD with suspicion of diffuse myocardial changes
3D cine	Easy to acquire Short acquisition times Free-breathing acquisition Reformatting any plane within the 3D volume is possible	Image resolution is lower compared with 2D cine Possible side effects when contrast agent is given	Not everywhere available	Can be applied to every patient with CHD
Diffusion tensor imaging	Can assess the relationship between ventricular function and structure	Time-consuming Relatively low spatial resolution	Not everywhere available	Not ready for routine clinical use
Lymphatic imaging	Easy to acquire Can increase our understanding of lymphatic pathologies Can help in planning lymphatic interventions	Dynamic MRL is invasive Possible side effects when contrast agent is given	Widely available	Especially used in single-ventricle patients on the Fontan pathway or with an established Fontan circulation
Foetal MRI	Has the potential to evaluate foetal cardiovascular anatomy and physiology Might help to assess foetal interventions	Might be challenging due to foetal size and movement, high foetal heart rates as well as to difficulties in cardiac gating Largely limited to the third trimester	Not everywhere available. Specific gating or reconstruction methods are needed	Can be used to assess foetal cardiovascular anatomy and haemodynamics. Assessment of foetal interventions might be possible.
Stress MRI	Easy to acquire Can provide important information on cardiovascular physiology and prognosis	Possible side effects of pharmacological stressors Some pharmacological stressors are not approved for children Physical exercise is not possible in every patient (e.g. small children)	Pharmacological stress is widely available MR-ergometer stress testing is not everywhere available	In patients with suspected coronary artery pathology in the setting of CHD or acquired paediatric heart disease (e.g. transposition of the great arteries, Kawasaki syndrome)
Catheter MRI	Gold standard for assessment of pulmonary vascular resistance Pure MR-guided diagnostic measurements without radiation are possible	Can be time-consuming MRI-approved catheters and other MR conditional materials are still limited MRI conditional haemodynamic measurement systems, screens for visualization, and communication systems are normally needed	Not everywhere available	Pulmonary vascular resistance measurements are well approved in patients with a Fontan circulation or with pulmonary hypertension
Computational fluid dynamics	Can be used for virtual therapy planning Can improve our understanding of disease haemodynamics	Time-consuming Expertise knowledge in simulation methods is needed Software is not everywhere available	Not everywhere available	CFD has been mainly applied in assessing Fontan connections and in patients with aortic diseases. Other applications are possible.
Deep learning	Can improve image acquisition, reconstruction and analysis (faster acquisition, standardization of image analysis)	Time-consuming Expertise knowledge in neural networks is needed	Not everywhere available	Segmentation of 2D and 3D image data sets (e. g. volumetric measurements)
Strain imaging	Can be applied to routinely acquired cine images Commercial analysis software is widely available Analysis times are short Provides additional functional information Might be able to detect early ventricular dysfunction	Strain values might not be interchangeable between vendors Lower spatial and temporal resolutions compared with speckle tracking echocardiography Segmental strain values are less reliable	Widely available	Can be applied to every patient with CHD, especially in the context of ventricular dysfunction.
3D printing	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.
Virtual/augmented reality	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming Software and head-mounted displays are needed	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.

Technology	Advantages	Disadvantages	Availability	Applications in CHD
4D Flow	Planning the acquisition volume is easy Multi-dimensional analysis of blood flow Quantification of multiple haemodynamic markers Commercial analysis software is widely available	Can be time-consuming	Widely available	Can be applied to every patient with CHD for blood flow assessment (e.g. stroke volumes, regurgitant volumes, Qp/Qs)
Mapping techniques	Easy to acquire Short acquisition times Provides additional information about myocardial tissue characteristics (diffuse changes) Commercial analysis software is widely available	Reference values for every MR machine need to be established Possible side effects when contrast agent is given for ECV calculation	Widely available	Can be applied to every patient with CHD with suspicion of diffuse myocardial changes
3D cine	Easy to acquire Short acquisition times Free-breathing acquisition Reformatting any plane within the 3D volume is possible	Image resolution is lower compared with 2D cine Possible side effects when contrast agent is given	Not everywhere available	Can be applied to every patient with CHD
Diffusion tensor imaging	Can assess the relationship between ventricular function and structure	Time-consuming Relatively low spatial resolution	Not everywhere available	Not ready for routine clinical use
Lymphatic imaging	Easy to acquire Can increase our understanding of lymphatic pathologies Can help in planning lymphatic interventions	Dynamic MRL is invasive Possible side effects when contrast agent is given	Widely available	Especially used in single-ventricle patients on the Fontan pathway or with an established Fontan circulation
Foetal MRI	Has the potential to evaluate foetal cardiovascular anatomy and physiology Might help to assess foetal interventions	Might be challenging due to foetal size and movement, high foetal heart rates as well as to difficulties in cardiac gating Largely limited to the third trimester	Not everywhere available. Specific gating or reconstruction methods are needed	Can be used to assess foetal cardiovascular anatomy and haemodynamics. Assessment of foetal interventions might be possible.
Stress MRI	Easy to acquire Can provide important information on cardiovascular physiology and prognosis	Possible side effects of pharmacological stressors Some pharmacological stressors are not approved for children Physical exercise is not possible in every patient (e.g. small children)	Pharmacological stress is widely available MR-ergometer stress testing is not everywhere available	In patients with suspected coronary artery pathology in the setting of CHD or acquired paediatric heart disease (e.g. transposition of the great arteries, Kawasaki syndrome)
Catheter MRI	Gold standard for assessment of pulmonary vascular resistance Pure MR-guided diagnostic measurements without radiation are possible	Can be time-consuming MRI-approved catheters and other MR conditional materials are still limited MRI conditional haemodynamic measurement systems, screens for visualization, and communication systems are normally needed	Not everywhere available	Pulmonary vascular resistance measurements are well approved in patients with a Fontan circulation or with pulmonary hypertension
Computational fluid dynamics	Can be used for virtual therapy planning Can improve our understanding of disease haemodynamics	Time-consuming Expertise knowledge in simulation methods is needed Software is not everywhere available	Not everywhere available	CFD has been mainly applied in assessing Fontan connections and in patients with aortic diseases. Other applications are possible.
Deep learning	Can improve image acquisition, reconstruction and analysis (faster acquisition, standardization of image analysis)	Time-consuming Expertise knowledge in neural networks is needed	Not everywhere available	Segmentation of 2D and 3D image data sets (e. g. volumetric measurements)
Strain imaging	Can be applied to routinely acquired cine images Commercial analysis software is widely available Analysis times are short Provides additional functional information Might be able to detect early ventricular dysfunction	Strain values might not be interchangeable between vendors Lower spatial and temporal resolutions compared with speckle tracking echocardiography Segmental strain values are less reliable	Widely available	Can be applied to every patient with CHD, especially in the context of ventricular dysfunction.
3D printing	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.
Virtual/augmented reality	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming Software and head-mounted displays are needed	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.

CHD, congenital heart disease; CFD, computational fluid dynamics; ECV, extracellular volume; MR, magnetic resonance; MRI, magnetic resonance imaging; 3D, three-dimensional; 2D, two-dimensional.

Table 1

Open in new tab

Advantages, disadvantages, availability, and applications of novel technologies in CHD

Technology	Advantages	Disadvantages	Availability	Applications in CHD
4D Flow	Planning the acquisition volume is easy Multi-dimensional analysis of blood flow Quantification of multiple haemodynamic markers Commercial analysis software is widely available	Can be time-consuming	Widely available	Can be applied to every patient with CHD for blood flow assessment (e.g. stroke volumes, regurgitant volumes, Qp/Qs)
Mapping techniques	Easy to acquire Short acquisition times Provides additional information about myocardial tissue characteristics (diffuse changes) Commercial analysis software is widely available	Reference values for every MR machine need to be established Possible side effects when contrast agent is given for ECV calculation	Widely available	Can be applied to every patient with CHD with suspicion of diffuse myocardial changes
3D cine	Easy to acquire Short acquisition times Free-breathing acquisition Reformatting any plane within the 3D volume is possible	Image resolution is lower compared with 2D cine Possible side effects when contrast agent is given	Not everywhere available	Can be applied to every patient with CHD
Diffusion tensor imaging	Can assess the relationship between ventricular function and structure	Time-consuming Relatively low spatial resolution	Not everywhere available	Not ready for routine clinical use
Lymphatic imaging	Easy to acquire Can increase our understanding of lymphatic pathologies Can help in planning lymphatic interventions	Dynamic MRL is invasive Possible side effects when contrast agent is given	Widely available	Especially used in single-ventricle patients on the Fontan pathway or with an established Fontan circulation
Foetal MRI	Has the potential to evaluate foetal cardiovascular anatomy and physiology Might help to assess foetal interventions	Might be challenging due to foetal size and movement, high foetal heart rates as well as to difficulties in cardiac gating Largely limited to the third trimester	Not everywhere available. Specific gating or reconstruction methods are needed	Can be used to assess foetal cardiovascular anatomy and haemodynamics. Assessment of foetal interventions might be possible.
Stress MRI	Easy to acquire Can provide important information on cardiovascular physiology and prognosis	Possible side effects of pharmacological stressors Some pharmacological stressors are not approved for children Physical exercise is not possible in every patient (e.g. small children)	Pharmacological stress is widely available MR-ergometer stress testing is not everywhere available	In patients with suspected coronary artery pathology in the setting of CHD or acquired paediatric heart disease (e.g. transposition of the great arteries, Kawasaki syndrome)
Catheter MRI	Gold standard for assessment of pulmonary vascular resistance Pure MR-guided diagnostic measurements without radiation are possible	Can be time-consuming MRI-approved catheters and other MR conditional materials are still limited MRI conditional haemodynamic measurement systems, screens for visualization, and communication systems are normally needed	Not everywhere available	Pulmonary vascular resistance measurements are well approved in patients with a Fontan circulation or with pulmonary hypertension
Computational fluid dynamics	Can be used for virtual therapy planning Can improve our understanding of disease haemodynamics	Time-consuming Expertise knowledge in simulation methods is needed Software is not everywhere available	Not everywhere available	CFD has been mainly applied in assessing Fontan connections and in patients with aortic diseases. Other applications are possible.
Deep learning	Can improve image acquisition, reconstruction and analysis (faster acquisition, standardization of image analysis)	Time-consuming Expertise knowledge in neural networks is needed	Not everywhere available	Segmentation of 2D and 3D image data sets (e. g. volumetric measurements)
Strain imaging	Can be applied to routinely acquired cine images Commercial analysis software is widely available Analysis times are short Provides additional functional information Might be able to detect early ventricular dysfunction	Strain values might not be interchangeable between vendors Lower spatial and temporal resolutions compared with speckle tracking echocardiography Segmental strain values are less reliable	Widely available	Can be applied to every patient with CHD, especially in the context of ventricular dysfunction.
3D printing	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.
Virtual/augmented reality	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming Software and head-mounted displays are needed	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.

Technology	Advantages	Disadvantages	Availability	Applications in CHD
4D Flow	Planning the acquisition volume is easy Multi-dimensional analysis of blood flow Quantification of multiple haemodynamic markers Commercial analysis software is widely available	Can be time-consuming	Widely available	Can be applied to every patient with CHD for blood flow assessment (e.g. stroke volumes, regurgitant volumes, Qp/Qs)
Mapping techniques	Easy to acquire Short acquisition times Provides additional information about myocardial tissue characteristics (diffuse changes) Commercial analysis software is widely available	Reference values for every MR machine need to be established Possible side effects when contrast agent is given for ECV calculation	Widely available	Can be applied to every patient with CHD with suspicion of diffuse myocardial changes
3D cine	Easy to acquire Short acquisition times Free-breathing acquisition Reformatting any plane within the 3D volume is possible	Image resolution is lower compared with 2D cine Possible side effects when contrast agent is given	Not everywhere available	Can be applied to every patient with CHD
Diffusion tensor imaging	Can assess the relationship between ventricular function and structure	Time-consuming Relatively low spatial resolution	Not everywhere available	Not ready for routine clinical use
Lymphatic imaging	Easy to acquire Can increase our understanding of lymphatic pathologies Can help in planning lymphatic interventions	Dynamic MRL is invasive Possible side effects when contrast agent is given	Widely available	Especially used in single-ventricle patients on the Fontan pathway or with an established Fontan circulation
Foetal MRI	Has the potential to evaluate foetal cardiovascular anatomy and physiology Might help to assess foetal interventions	Might be challenging due to foetal size and movement, high foetal heart rates as well as to difficulties in cardiac gating Largely limited to the third trimester	Not everywhere available. Specific gating or reconstruction methods are needed	Can be used to assess foetal cardiovascular anatomy and haemodynamics. Assessment of foetal interventions might be possible.
Stress MRI	Easy to acquire Can provide important information on cardiovascular physiology and prognosis	Possible side effects of pharmacological stressors Some pharmacological stressors are not approved for children Physical exercise is not possible in every patient (e.g. small children)	Pharmacological stress is widely available MR-ergometer stress testing is not everywhere available	In patients with suspected coronary artery pathology in the setting of CHD or acquired paediatric heart disease (e.g. transposition of the great arteries, Kawasaki syndrome)
Catheter MRI	Gold standard for assessment of pulmonary vascular resistance Pure MR-guided diagnostic measurements without radiation are possible	Can be time-consuming MRI-approved catheters and other MR conditional materials are still limited MRI conditional haemodynamic measurement systems, screens for visualization, and communication systems are normally needed	Not everywhere available	Pulmonary vascular resistance measurements are well approved in patients with a Fontan circulation or with pulmonary hypertension
Computational fluid dynamics	Can be used for virtual therapy planning Can improve our understanding of disease haemodynamics	Time-consuming Expertise knowledge in simulation methods is needed Software is not everywhere available	Not everywhere available	CFD has been mainly applied in assessing Fontan connections and in patients with aortic diseases. Other applications are possible.
Deep learning	Can improve image acquisition, reconstruction and analysis (faster acquisition, standardization of image analysis)	Time-consuming Expertise knowledge in neural networks is needed	Not everywhere available	Segmentation of 2D and 3D image data sets (e. g. volumetric measurements)
Strain imaging	Can be applied to routinely acquired cine images Commercial analysis software is widely available Analysis times are short Provides additional functional information Might be able to detect early ventricular dysfunction	Strain values might not be interchangeable between vendors Lower spatial and temporal resolutions compared with speckle tracking echocardiography Segmental strain values are less reliable	Widely available	Can be applied to every patient with CHD, especially in the context of ventricular dysfunction.
3D printing	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.
Virtual/augmented reality	Can help in planning surgical or interventional procedures Can be useful in teaching	High-resolution 3D data set must be acquired Segmentation software is needed Segmentation can be time-consuming Software and head-mounted displays are needed	Not everywhere available	To plan surgical procedures in complex CHD. To plan complex interventions in CHD. To teach students or physicians.

CHD, congenital heart disease; CFD, computational fluid dynamics; ECV, extracellular volume; MR, magnetic resonance; MRI, magnetic resonance imaging; 3D, three-dimensional; 2D, two-dimensional.

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