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He Y, Northrup H, Le H, Cheung AK, Berceli SA, Shiu YT. Medical Image-Based Computational Fluid Dynamics and Fluid-Structure Interaction Analysis in Vascular Diseases. Front Bioeng Biotechnol 2022; 10:855791. [PMID: 35573253 PMCID: PMC9091352 DOI: 10.3389/fbioe.2022.855791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 01/17/2023] Open
Abstract
Hemodynamic factors, induced by pulsatile blood flow, play a crucial role in vascular health and diseases, such as the initiation and progression of atherosclerosis. Computational fluid dynamics, finite element analysis, and fluid-structure interaction simulations have been widely used to quantify detailed hemodynamic forces based on vascular images commonly obtained from computed tomography angiography, magnetic resonance imaging, ultrasound, and optical coherence tomography. In this review, we focus on methods for obtaining accurate hemodynamic factors that regulate the structure and function of vascular endothelial and smooth muscle cells. We describe the multiple steps and recent advances in a typical patient-specific simulation pipeline, including medical imaging, image processing, spatial discretization to generate computational mesh, setting up boundary conditions and solver parameters, visualization and extraction of hemodynamic factors, and statistical analysis. These steps have not been standardized and thus have unavoidable uncertainties that should be thoroughly evaluated. We also discuss the recent development of combining patient-specific models with machine-learning methods to obtain hemodynamic factors faster and cheaper than conventional methods. These critical advances widen the use of biomechanical simulation tools in the research and potential personalized care of vascular diseases.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - Hannah Northrup
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ha Le
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
- Vascular Surgery Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Yan Tin Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
- *Correspondence: Yan Tin Shiu,
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52
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Berhane H, Scott MB, Barker AJ, McCarthy P, Avery R, Allen B, Malaisrie C, Robinson JD, Rigsby CK, Markl M. Deep learning-based velocity antialiasing of 4D-flow MRI. Magn Reson Med 2022; 88:449-463. [PMID: 35381116 PMCID: PMC9050855 DOI: 10.1002/mrm.29205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 01/03/2023]
Abstract
Purpose To develop a convolutional neural network (CNN) for the robust and fast correction of velocity aliasing in 4D‐flow MRI. Methods This study included 667 adult subjects with aortic 4D‐flow MRI data with existing velocity aliasing (n = 362) and no velocity aliasing (n = 305). Additionally, 10 controls received back‐to‐back 4D‐flow scans with systemically varied velocity‐encoding sensitivity (vencs) at 60, 100, and 175 cm/s. The no‐aliasing data sets were used to simulate velocity aliasing by reducing the venc to 40%–70% of the original, alongside a ground truth locating all aliased voxels (153 training, 152 testing). The 152 simulated and 362 existing aliasing data sets were used for testing and compared with a conventional velocity antialiasing algorithm. Dice scores were calculated to quantify CNN performance. For controls, the venc 175‐cm/s scans were used as the ground truth and compared with the CNN‐corrected venc 60 and 100 cm/s data sets Results The CNN required 176 ± 30 s to perform compared with 162 ± 14 s for the conventional algorithm. The CNN showed excellent performance for the simulated data compared with the conventional algorithm (median range of Dice scores CNN: [0.89–0.99], conventional algorithm: [0.84–0.94], p < 0.001, across all simulated vencs) and detected more aliased voxels in existing velocity aliasing data sets (median detected CNN: 159 voxels [31–605], conventional algorithm: 65 [7–417], p < 0.001). For controls, the CNN showed Dice scores of 0.98 [0.95–0.99] and 0.96 [0.87–0.99] for venc = 60 cm/s and 100 cm/s, respectively, while flow comparisons showed moderate‐excellent agreement. Conclusion Deep learning enabled fast and robust velocity anti‐aliasing in 4D‐flow MRI.
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Affiliation(s)
- Haben Berhane
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Michael B. Scott
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Alex J. Barker
- Anschutz Medical CampusUniversity of ColoradoAuroraColoradoUSA
| | - Patrick McCarthy
- Division of Cardiac SurgeryNorthwestern MedicineChicagoIllinoisUSA
| | - Ryan Avery
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Brad Allen
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Chris Malaisrie
- Division of Cardiac SurgeryNorthwestern MedicineChicagoIllinoisUSA
| | - Joshua D. Robinson
- Department of Medical ImagingLurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Cynthia K. Rigsby
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
- Department of Medical ImagingLurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Michael Markl
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
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53
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Guglielmo M, Rovera C, Rabbat MG, Pontone G. The Role of Cardiac Magnetic Resonance in Aortic Stenosis and Regurgitation. J Cardiovasc Dev Dis 2022; 9:108. [PMID: 35448084 PMCID: PMC9030119 DOI: 10.3390/jcdd9040108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is a well-set diagnostic technique for assessment of valvular heart diseases and is gaining ground in current clinical practice. It provides high-quality images without the administration of ionizing radiation and occasionally without the need of contrast agents. It offers the unique possibility of a comprehensive stand-alone assessment of the heart including biventricular function, left ventricle remodeling, myocardial fibrosis, and associated valvulopathies. CMR is the recognized reference for the quantification of ventricular volumes, mass, and function. A particular strength is the ability to quantify flow, especially with new techniques which allow accurate measurement of stenosis and regurgitation. Furthermore, tissue mapping enables the visualization and quantification of structural changes in the myocardium. In this way, CMR has the potential to yield important prognostic information predicting those patients who will progress to surgery and impact outcomes. In this review, the fundamentals of CMR in assessment of aortic valve diseases (AVD) are described, together with its strengths and weaknesses. This state-of-the-art review provides an updated overview of CMR potentials in all AVD issues, including valve anatomy, flow quantification, ventricular volumes and function, and tissue characterization.
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Affiliation(s)
- Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.G.); (C.R.)
| | - Chiara Rovera
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.G.); (C.R.)
| | - Mark G. Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL 60611, USA;
- Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.G.); (C.R.)
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54
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Del Torto A, Guaricci AI, Pomarico F, Guglielmo M, Fusini L, Monitillo F, Santoro D, Vannini M, Rossi A, Muscogiuri G, Baggiano A, Pontone G. Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2022; 9:758975. [PMID: 35355965 PMCID: PMC8959466 DOI: 10.3389/fcvm.2022.758975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a syndrome defined by the presence of heart failure symptoms and increased levels of circulating natriuretic peptide (NP) in patients with preserved left ventricular ejection fraction and various degrees of diastolic dysfunction (DD). HFpEF is a complex condition that encompasses a wide range of different etiologies. Cardiovascular imaging plays a pivotal role in diagnosing HFpEF, in identifying specific underlying etiologies, in prognostic stratification, and in therapeutic individualization. Echocardiography is the first line imaging modality with its wide availability; it has high spatial and temporal resolution and can reliably assess systolic and diastolic function. Cardiovascular magnetic resonance (CMR) is the gold standard for cardiac morphology and function assessment, and has superior contrast resolution to look in depth into tissue changes and help to identify specific HFpEF etiologies. Differently, the most important role of nuclear imaging [i.e., planar scintigraphy and/or single photon emission CT (SPECT)] consists in the screening and diagnosis of cardiac transthyretin amyloidosis (ATTR) in patients with HFpEF. Cardiac CT can accurately evaluate coronary artery disease both from an anatomical and functional point of view, but tissue characterization methods have also been developed. The aim of this review is to critically summarize the current uses and future perspectives of echocardiography, nuclear imaging, CT, and CMR in patients with HFpEF.
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Affiliation(s)
- Alberico Del Torto
- Department of Emergency and Acute Cardiac Care, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Daniela Santoro
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Monica Vannini
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- University Milano Bicocca, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
- *Correspondence: Gianluca Pontone
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Takahashi K, Sekine T, Ando T, Ishii Y, Kumita S. Utility of 4D Flow MRI in Thoracic Aortic Diseases: A Literature Review of Clinical Applications and Current Evidence. Magn Reson Med Sci 2022; 21:327-339. [PMID: 34497166 PMCID: PMC9680552 DOI: 10.2463/mrms.rev.2021-0046] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/17/2021] [Indexed: 11/09/2022] Open
Abstract
Despite the recent technical developments, surgery on the thoracic aorta remains challenging and is associated with significant mortality and morbidity. Decisions about when and if to operate are based on a balance between surgical risk and the hazard of aortic rupture. These decisions are sometimes difficult in elective cases of thoracic aortic diseases, including aneurysms and dissections. Abnormal wall stress derived from flow alterations influences disease progression. Therefore, a better understanding of the complex hemodynamic environment inside the aortic lumen will facilitate patient-specific risk assessments of complications, which enable clinicians to provide timely prophylactic interventions. Time-resolved 3D phase-contrast (4D flow) MRI has many advantages for the in vivo assessment of flow dynamics. Recent developments in 4D flow imaging techniques has led to significant advances in our understanding of physiological flow dynamics in healthy subjects and patients with thoracic aortic diseases. In this clinically focused review of thoracic aortic diseases, we demonstrate the clinical advances acquired with 4D flow MRI from published studies. We provide a systematic overview of key evidences and considerations regarding normal thoracic aortas, thoracic aortic aneurysms, aortic dissections, and thoracic aortas with prosthetic graft replacement.
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Affiliation(s)
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
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Sekine T, Nakaza M, Matsumoto M, Ando T, Inoue T, Sakamoto SI, Maruyama M, Obara M, Leonowicz O, Usuda J, Kumita S. 4D Flow MR Imaging of the Left Atrium: What is Non-physiological Blood Flow in the Cardiac System? Magn Reson Med Sci 2022; 21:293-308. [PMID: 35185085 PMCID: PMC9680542 DOI: 10.2463/mrms.rev.2021-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 01/30/2024] Open
Abstract
Most cardiac diseases cause a non-physiological blood flow pattern known as turbulence around the heart and great vessels, which further worsen the disease itself. However, there is no consensus on how blood flow can be defined in disease conditions. Especially, in the left atrium, the fact that vortex flow already exists makes this debate more complicated. 3D time-resolved phase-contrast (4D flow) MRI is expected to be able to capture blood flow patterns from multiple aspects, such as blood flow velocity, stasis, and vortex quantification. Previous studies have confirmed that physiological vortex flow is predominantly induced by the higher-volume flow from the superior left pulmonary vein. In atrial fibrillation, 4D flow MRI reveals a non-physiological blood flow pattern, which information may add value to well-established clinical risk factors. Currently, the research target of LA analysis has also widened to lung surgeons, pulmonary vein stump thrombosis after left upper lobectomy. 4D flow MRI is expected to be utilized for many more variable diseases that are currently unimaginable.
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Affiliation(s)
- Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Masatoki Nakaza
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Mitsuo Matsumoto
- Department of Thoracic Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School, Nagayama Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shun-Ichiro Sakamoto
- Department of Cardiovascular Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Mitsunori Maruyama
- Department of Cardiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | | | | | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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Rivera-Rivera LA. Editorial for "Does the Internal Carotid Artery Attenuate Blood-Flow Pulsatility in Small Vessel Disease? A 7T 4D-Flow MRI Study". J Magn Reson Imaging 2022; 56:536-537. [PMID: 34997661 DOI: 10.1002/jmri.28055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Leonardo A Rivera-Rivera
- Departments of Medicine and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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58
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Management of patients with single ventricle physiology across the lifespan: contributions from magnetic resonance and computed tomography imaging. Can J Cardiol 2022; 38:946-962. [DOI: 10.1016/j.cjca.2022.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 01/02/2022] [Indexed: 12/12/2022] Open
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Ha SY, Kang Y, Lee HJ, Hwang M, Baik J, Park S. Intracranial Flow Velocity Quantification Using Non-Contrast Four-Dimensional Flow MRI: A Prospective Comparative Study with Transcranial Doppler Ultrasound. Diagnostics (Basel) 2021; 12:diagnostics12010023. [PMID: 35054190 PMCID: PMC8774649 DOI: 10.3390/diagnostics12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Four-dimensional (4D) flow magnetic resonance imaging (MRI) allows three-dimensional velocity encoding to measure blood flow in a single scan, regardless of the intracranial artery direction. We compared blood flow velocity quantification by non-contrast 4D flow MRI and by transcranial Doppler ultrasound (TCD), the most widely used modality for measuring velocity. Twenty-two patients underwent both TCD and non-contrast 4D flow MRI. The mean time interval between TCD and non-contrast 4D flow MRI was 0.7 days. Subsegmental velocities were measured bilaterally in the middle cerebral and basilar arteries using TCD and non-contrast 4D flow MRI. Intracranial velocity measurements using TCD and non-contrast 4D flow MRI demonstrated a strong correlation in the bilateral M1, especially at the proximal segment (right r = 0.74, left r = 0.78; all p < 0.001). Mean velocities acquired with 4D flow MRI were approximately 8 to 10% lower than those acquired with TCD according to the location of M1. Intracranial arterial flow measurements estimated using non-contrast 4D flow MRI and TCD showed strong correlation. 4D flow MRI enables simultaneous assessment of vascular morphology and quantitative hemodynamic measurement, providing three-dimensional blood flow visualization. 4D flow MRI is a clinically useful sequence with a promising role in cerebrovascular disease.
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Affiliation(s)
- Sam-Yeol Ha
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (S.-Y.H.); (S.P.)
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (H.-J.L.); (J.B.)
- Correspondence: ; Tel.: +82-51-797-0340; Fax: +82-51-797-0379
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (H.-J.L.); (J.B.)
| | | | - Jiyeon Baik
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (H.-J.L.); (J.B.)
- Department of Radiology, Good Gang-An Hospital, Busan 48265, Korea
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (S.-Y.H.); (S.P.)
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Cardiorresonancia magnética con 4D Flow en la valoración previa y posterior a la corrección de drenaje venoso pulmonar anómalo parcial. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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61
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Urmeneta Ulloa J, Rivas Oyarzabal J, Cabrera JÁ, Álvarez Vázquez A, Forteza Gil A, Martínez de Vega V. Cardiac magnetic resonance with 4D-flow in pre- and postcorrection assessment of partial anomalous pulmonary venous drainage. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:1112-1114. [PMID: 34257041 DOI: 10.1016/j.rec.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Javier Urmeneta Ulloa
- Departamento de Cardiología, Hospital Universitario Quirónsalud, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain; Instituto Chileno de Imagen Cardíaca (INCIC), Santiago de Chile, Chile.
| | | | - José Ángel Cabrera
- Departamento de Cardiología, Hospital Universitario Quirónsalud, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - Ana Álvarez Vázquez
- Universidad Europea de Madrid, Madrid, Spain; Departamento de Radiología, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Alberto Forteza Gil
- Departamento de Cirugía Cardiaca, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Vicente Martínez de Vega
- Universidad Europea de Madrid, Madrid, Spain; Departamento de Radiología, Hospital Universitario Quirónsalud, Madrid, Spain
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Korpela T, Kauhanen SP, Kariniemi E, Saari P, Liimatainen T, Jaakkola P, Vanninen R, Hedman M. Flow displacement and decreased wall shear stress might be associated with the growth rate of an ascending aortic dilatation. Eur J Cardiothorac Surg 2021; 61:395-402. [PMID: 34791134 PMCID: PMC8788001 DOI: 10.1093/ejcts/ezab483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Our goal was to evaluate whether four-dimensional (4D) flow magnetic resonance imaging (MRI) can predict the growth rate of dilatation of the ascending aorta (AA) in patients with a tricuspid, normally functioning aortic valve. METHODS In this prospective clinical study, aortic 4D flow MRI was performed at the Kuopio University Hospital on 30 patients diagnosed with AA dilatation (maximum diameter >40 mm) between August 2017 and July 2020. The MRI was repeated after a 1-year follow-up, with AA dimensions and 4D flow parameters analysed retrospectively at both time points. The standard error of measurement was used to assess the statistical significance of the growth rate of AA dilatation. Flow displacement (FD) was transformed to a class-scaled parameter using FD ≥5% as a threshold. RESULTS Statistically significant growth [median 2.1 mm (1.5–2.2 mm); P = 0.03] was detected in 6 male patients (20%); the AA diameter remained unchanged [0.2 mm (−0.3 to 0.9 mm)] in 24 patients (80%). An increased FD at the baseline was associated with significant growth during the 1-year follow-up in the proximal AA. An association was detected between decreased total wall shear stress and significant aortic growth in the inner curve of the sinotubular junction [529 mPa (449–664 mPa) vs 775 mPa (609–944 mPa); P = 0.03] and the anterior side of the proximal aortic arch [356 mPa (305–367 mPa) vs 493 mPa (390–586 mPa); P < 0.001]. CONCLUSIONS FD and decreased wall shear stress seem to be associated with significant growth of AA dilatation at the 1-year follow-up. Thus, 4D flow MRI might be useful in assessing risk for AA diameter growth in patients with a tricuspid aortic valve.
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Affiliation(s)
- Tarmo Korpela
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland.,Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Finland
| | - S Petteri Kauhanen
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Elina Kariniemi
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Pekka Jaakkola
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Marja Hedman
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland.,Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
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63
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Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg 2021; 11:4193-4210. [PMID: 34476199 DOI: 10.21037/qims-20-1234] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Abstract
Magnetic resonance imaging (MRI) four-dimensional (4D) flow is a type of phase-contrast (PC) MRI that uses blood flow encoded in 3 directions, which is resolved relative to 3 spatial and temporal dimensions of cardiac circulation. It can be used to simultaneously quantify and visualize hemodynamics or morphology disorders. 4D flow MRI is more comprehensive and accurate than two-dimensional (2D) PC MRI and echocardiography. 4D flow MRI provides numerous hemodynamic parameters that are not limited to the basic 2D parameters, including wall shear stress (WSS), pulse wave velocity (PWV), kinetic energy, turbulent kinetic energy (TKE), pressure gradient, and flow component analysis. 4D flow MRI is widely used to image many parts of the body, such as the neck, brain, and liver, and has a wide application spectrum to cardiac diseases and large vessels. This present review aims to summarize the hemodynamic parameters of 4D flow MRI technology and generalize their usefulness in clinical practice in relation to the cardiovascular system. In addition, we note the improvements that have been made to 4D flow MRI with the application of new technologies. The application of new technologies can improve the speed of 4D flow, which would benefit clinical applications.
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Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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Doyle CM, Orr J, Greenwood JP, Plein S, Tsoumpas C, Bissell MM. Four-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review. J Magn Reson Imaging 2021; 55:1301-1321. [PMID: 34416048 DOI: 10.1002/jmri.27874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Four-dimensional (4D) flow magnetic resonance imaging (MRI) allows multidirectional quantification of blood flow in the heart and great vessels. Comparability of the technique to the current reference standards of flow assessment-two-dimensional (2D) flow MRI and Doppler echocardiography-varies in the literature. Image acquisition parameters likely impact upon the accuracy and reproducibility of 4D flow MRI. We therefore sought to review the current literature on 4D flow MRI in the heart and great vessels, in comparison to 2D flow MRI, Doppler echocardiography, and invasive catheterization. Using a predefined search strategy and inclusion and exclusion criteria, the databases EMBASE and Medline were searched in January 2021 for peer-reviewed research articles comparing cardiac 4D flow MRI to 2D flow MRI, Doppler echocardiography and/or invasive catheterization. The data from all relevant articles were assimilated and analyzed using Mann-Whitney U and chi χ2 test. Forty-four manuscripts met the eligibility criteria and were included in the review. The review showed agreement of 4D flow MRI to the reference standard methods of flow assessment, particular in the measurement of peak velocity and stroke volume in 55% of manuscripts. The use of valve tracking significantly improves agreement between 4D flow MRI and the reference modalities (79% matching with the use of valve tracking vs. 50% without, P = 0.04). This review highlights that the impact of acquisition parameters on 4D flow MRI accuracy is multifactorial. It is therefore important that each center conducts its own quality assurance prior to using 4D flow MRI for clinical decision-making. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ciara M Doyle
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Jenny Orr
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - John P Greenwood
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Charalampos Tsoumpas
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK.,Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
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Wang L, Liu M, Zhang PY, Dai JZ, Ma HY, Tao XC, Xie WM, Wan J, Jing A. Analysis of right ventricular flow with 4-dimensional flow cardiovascular magnetic resonance imaging in patients with pulmonary arterial hypertension. Quant Imaging Med Surg 2021; 11:3655-3665. [PMID: 34341739 DOI: 10.21037/qims-20-1267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/09/2021] [Indexed: 01/19/2023]
Abstract
Background Cardiac flow closely interact with function, however, the correlation of right ventricular (RV) flow and function remains unknown, thus our objective is to observe right ventricular flow with four-dimensional phase-contrast cardiovascular magnetic resonance imaging (4D flow CMR) in patients with pulmonary arterial hypertension (PAH) and to analyze flow components with RV function and hemodynamics. Methods This study retrospectively enrolled 30 patients with PAH (mean age: 49±13 years, 16 females) and 14 age- and sex-matched healthy volunteers as controls (mean age: 44±12 years, 9 females). All patients who underwent CMR and right heart catheterization (RHC) within 1 week between January 2019 and July 2020 were included. Hemodynamics were measured with RHC. RV flow components, including the percentages of direct flow (RVPDF), retained inflow (RVPRI), delayed ejection flow (RVPDEF) and residual volume (RVPRVo) were quantified using 4D flow CMR. The associations between RV flow components and other CMR metrics, clinical data, and hemodynamics were analyzed by Spearman's correlation analysis. Results In patients with PAH, RVPDF was decreased and RVPRVo was increased compared with the normal control group. The sum of RVPDF and RVPDEF RV was significantly correlated with RV ejection fraction (RVEF) (r=0.802, P<0.001), and there was no notable difference between RVEF and the sum of RVPDF and RVPDEF (t=0.251, P=0.831). Both RVPDF and RVPRVo were correlated (in opposite directions) with the RV end-diastolic volume index, RV end-systolic volume index, RV global longitudinal strain, and RVEF. RVPDF was negatively correlated with pulmonary vascular resistance (PVR), and positively correlated with cardiac output and cardiac index. RVPRVo was positively correlated with PVR and negatively correlated with cardiac output and cardiac index. Conclusions RV blood flow components qualified with 4D flow CMR is a valuable noninvasive method for the assessment of RV function and hemodynamics in patients with PAH.
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Affiliation(s)
- Lei Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Pei Yao Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Jin Zhu Dai
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Hai Yi Ma
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xin Cao Tao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Wan Mu Xie
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - An Jing
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
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Oyama-Manabe N, Aikawa T, Tsuneta S, Manabe O. Clinical Applications of 4D Flow MR Imaging in Aortic Valvular and Congenital Heart Disease. Magn Reson Med Sci 2021; 21:319-326. [PMID: 34176866 DOI: 10.2463/mrms.rev.2021-0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
4D flow MRI allows time-resolved 3D velocity-encoded phase-contrast imaging for 3D visualization and quantification of aortic and intracardiac flow. Radiologists should be familiar with the principles of 4D flow MRI and methods for evaluating blood flow qualitatively and quantitatively. The most substantial benefits of 4D flow MRI are that it enables the simultaneous comprehensive assessment of different vessels, and that retrospective analysis can be achieved in all vessels in any direction in the field of view, which is especially beneficial for patients with complicated congenital heart disease (CHD). For aortic valvular diseases, new parameters such as wall shear stress and energy loss may provide new prognostic values for 4D flow MRI. In this review, we introduce the clinical applications of 4D flow MRI for the visualization of blood flow and quantification of hemodynamic metrics in the setting of aortic valvular disease and CHD, including intracardiac shunt and coronary artery anomaly.
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Affiliation(s)
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center
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Abstract
MRI is an essential diagnostic tool in the anatomic and functional evaluation of cardiovascular disease. In many practices, 2D phase-contrast (2D-PC) has been used for blood flow quantification. 4D Flow MRI is a time-resolved volumetric acquisition that captures the vector field of blood flow along with anatomic images. 4D Flow MRI provides a simpler acquisition compared to 2D-PC and facilitates a more accurate and comprehensive hemodynamic assessment. Advancements in accelerated imaging have significantly shortened scan times of 4D Flow MRI while preserving image quality, enabling this technology to transition from the research arena to routine clinical practice. In this article, we review technical optimization based on our clinical experience of over 10 years with 4D Flow MRI. We also present pearls and pitfalls in the practical application of 4D Flow MRI, including how to quantify cardiovascular shunts, valvular or vascular stenosis, and valvular regurgitation. As experience increases, and as 4D Flow sequences and post-processing software become more broadly available, 4D Flow MRI will likely become an essential component of cardiac imaging for practices involved in the management of congenital and acquired structural heart disease.
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68
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Mawad W, Løvstakken L, Fadnes S, Grønli T, Segers P, Mertens L, Nyrnes SA. Right Ventricular Flow Dynamics in Dilated Right Ventricles: Energy Loss Estimation Based on Blood Speckle Tracking Echocardiography-A Pilot Study in Children. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1514-1527. [PMID: 33685744 DOI: 10.1016/j.ultrasmedbio.2021.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/24/2020] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
Using blood speckle tracking (BST) based on high-frame-rate echocardiography (HFRE), we compared right ventricle (RV) flow dynamics in children with atrial septal defects (ASDs) and repaired tetralogy of Fallot (rTOF). Fifty-seven children with rTOF with severe pulmonary insufficiency (PI) (n = 21), large ASDs (n = 11) and healthy controls (CTL, n = 25) were included. Using a flow phantom, we studied the effects of imaging plane and smoothing parameters on 2-D energy loss (EL). RV diastolic EL was similar in ASD and rTOF, but both were greater than in CTL. Locations of high EL were similar in all groups in systole, occurring in the RV outflow tract and around the tricuspid valve leaflets in early diastole. An additional apical early diastolic area of EL was noted in rTOF, corresponding to colliding tricuspid inflow and PI. The flow phantom revealed that EL varied with imaging plane and smoothing settings but that the EL trend was preserved if kept consistent.
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Affiliation(s)
- Wadi Mawad
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Paediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Grønli
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Luc Mertens
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Siri Ann Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Children's Clinic, St. Olav's University Hospital, Trondheim, Norway
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Zhao X, Tan RS, Garg P, Chai P, Leng S, Bryant J, Teo LLS, Ong CC, Geest RJVD, Allen JC, Yip JW, Tan JL, Plein S, Westenberg JJW, Zhong L. Impact of age, sex and ethnicity on intra-cardiac flow components and left ventricular kinetic energy derived from 4D flow CMR. Int J Cardiol 2021; 336:105-112. [PMID: 34044022 DOI: 10.1016/j.ijcard.2021.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) allows quantification of left ventricular (LV) blood flow. We aimed to 1) establish reference ranges for 4D flow CMR-derived LV relative flow components and kinetic energy parameters indexed to end-diastolic volume (KEiEDV) among healthy Asian subjects, 2) assess effects of age and sex on these parameters, and 3) compare these parameters between Asian and Caucasian subjects. METHODS 74 healthy Asian subjects underwent cine and 4D flow CMR. Relative flow components (direct flow, retained inflow, delayed ejection flow, residual volume) and multiple phasic KEiEDV (LV global, peak systolic, systolic, diastolic, peak E-wave, peak A-wave) were analyzed. Sex- and age-specific reference ranges were reported. RESULTS Relative flow components and systolic phase KEiEDV did not vary with age. Women had higher retained inflow and peak E-wave KEiEDV, lower residual volume, peak systolic and systolic KEiEDV than men. Peak A-wave KEiEDV increased significantly (r = 0.474) whereas peak E-wave KEiEDV (r = -0.458) and E-wave/A-wave ratio (r = -0.528) decreased with age. A sub-population (n = 44) was compared with 44 sex- and age-matched Caucasian subjects: no significant group differences were observed for all 4D flow CMR parameters. CONCLUSION Asian sex- and age-specific 4D flow CMR reference ranges were established. Sex differences in retained inflow, residual volume, peak systolic, systolic KEiEDV and peak E-wave KEiEDV were observed. Ageing influenced diastolic KEiEDV but not systolic phase KEiEDV or relative flow components. All studied parameters were similar between sex- and age-matched Asian and Caucasian subjects, implying generalizability of the ranges.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Road, 169857, Singapore
| | - Pankaj Garg
- University of Sheffield, C Floor, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Ping Chai
- National University Hospital Singapore, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore
| | - Jennifer Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Ching Ching Ong
- National University Hospital Singapore, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - John C Allen
- Duke-NUS Medical School, National University of Singapore, 8 College Road, 169857, Singapore
| | - James W Yip
- National University Hospital Singapore, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Road, 169857, Singapore
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Jos J W Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Road, 169857, Singapore.
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Abnormal pulmonary flow is associated with impaired right ventricular coupling in patients with COPD. Int J Cardiovasc Imaging 2021; 37:3039-3048. [PMID: 34021434 DOI: 10.1007/s10554-021-02285-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 01/31/2023]
Abstract
Cor Pulmonale or right ventricular (RV) dysfunction due to pulmonary disease is an expected complication of COPD resulting primarily from increased afterload mediated by chronic alveolar hypoxemia and resulting hypoxic pulmonary vasoconstriction. Early detection of elevated RV afterload has been previously demonstrated by visualization of abnormal flow patterns in the proximal pulmonary arteries. Prior analysis of helicity in the pulmonary arteries in pulmonary hypertension patients has demonstrated a strong association between helicity and increased RV afterload. However, these flow hemodynamics have yet to be fully explored in patients with COPD. We hypothesized that patients with COPD will have abnormal pulmonary flow as evaluated by 4D-Flow MRI and associated with RV function and pulmonary arterial stiffness. Patients with COPD (n = 15) (65 years ± 6) and controls (n = 10) (58 years ± 9) underwent 4D-Flow MRI to calculate helicity. The helicity was calculated in the main pulmonary artery (MPA) and along the RV outflow tract (RVOT)-MPA axis. Main pulmonary arterial stiffness was measured using the relative area change (RAC). We found COPD patients had decreased helicity relative to healthy controls in the MPA (19.4 ± 7.8vs 32.8 ± 15.9, P = 0.007) and reduced helicity along the RVOT-MPA axis (33.2 ± 9.0 vs 43.5 ± 8.3, P = 0.010). Our investigation indicates a strong association between helicity along the MPA-RV outflow tract axis and RV function and suggests that 4D-Flow MRI might be a sensitive tool in evaluating RV-pulmonary arterial coupling in COPD.
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71
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Blood Flow Quantification in Peripheral Arterial Disease: Emerging Diagnostic Techniques in Vascular Surgery. Surg Technol Int 2021. [PMID: 33970476 DOI: 10.52198/21.sti.38.cv1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The assessment of local blood flow patterns in patients with peripheral arterial disease is clinically relevant, since these patterns are related to atherosclerotic disease progression and loss of patency in stents placed in peripheral arteries, through mechanisms such as recirculating flow and low wall shear stress (WSS). However, imaging of vascular flow in these patients is technically challenging due to the often complex flow patterns that occur near atherosclerotic lesions. While several flow quantification techniques have been developed that could improve the outcomes of vascular interventions, accurate 2D or 3D blood flow quantification is not yet used in clinical practice. This article provides an overview of several important topics that concern the quantification of blood flow in patients with peripheral arterial disease. The hemodynamic mechanisms involved in the development of atherosclerosis and the current clinical practice in the diagnosis of this disease are discussed, showing the unmet need for improved and validated flow quantification techniques in daily clinical practice. This discussion is followed by a showcase of state-of-the-art blood flow quantification techniques and how these could be used before, during and after treatment of stenotic lesions to improve clinical outcomes. These techniques include novel ultrasound-based methods, Phase-Contrast Magnetic Resonance Imaging (PC-MRI) and Computational Fluid Dynamics (CFD). The last section discusses future perspectives, with advanced (hybrid) imaging techniques and artificial intelligence, including the implementation of these techniques in clinical practice.
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Engelhard S, van de Velde L, Jebbink E, Jain K, Westenberg J, Zeebregts C, Versluis M, Reijnen M. Blood Flow Quantification in Peripheral Arterial Disease: Emerging Diagnostic Techniques in Vascular Surgery. Surg Technol Int 2021. [DOI: https:/doi.org/10.52198/21.sti.38.cv1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The assessment of local blood flow patterns in patients with peripheral arterial disease is clinically relevant, since these patterns are related to atherosclerotic disease progression and loss of patency in stents placed in peripheral arteries, through mechanisms such as recirculating flow and low wall shear stress (WSS). However, imaging of vascular flow in these patients is technically challenging due to the often complex flow patterns that occur near atherosclerotic lesions. While several flow quantification techniques have been developed that could improve the outcomes of vascular interventions, accurate 2D or 3D blood flow quantification is not yet used in clinical practice. This article provides an overview of several important topics that concern the quantification of blood flow in patients with peripheral arterial disease. The hemodynamic mechanisms involved in the development of atherosclerosis and the current clinical practice in the diagnosis of this disease are discussed, showing the unmet need for improved and validated flow quantification techniques in daily clinical practice. This discussion is followed by a showcase of state-of-the-art blood flow quantification techniques and how these could be used before, during and after treatment of stenotic lesions to improve clinical outcomes. These techniques include novel ultrasound-based methods, Phase-Contrast Magnetic Resonance Imaging (PC-MRI) and Computational Fluid Dynamics (CFD). The last section discusses future perspectives, with advanced (hybrid) imaging techniques and artificial intelligence, including the implementation of these techniques in clinical practice.
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Affiliation(s)
- Stefan Engelhard
- Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands
| | | | - Erik Jebbink
- Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands
| | - Kartik Jain
- Department of Thermal and Fluid Engineering, University of Twente, Enschede, The Netherlands
| | - Jos Westenberg
- Department of Radiology, Cardiovascular Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
| | - Clark Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
| | - Michel Reijnen
- Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands
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Casciaro ME, Pascaner AF, Guilenea FN, Alcibar J, Gencer U, Soulat G, Mousseaux E, Craiem D. 4D flow MRI: impact of region of interest size, angulation and spatial resolution on aortic flow assessment. Physiol Meas 2021; 42. [PMID: 33567412 DOI: 10.1088/1361-6579/abe525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/10/2021] [Indexed: 12/31/2022]
Abstract
Objectives.In cardiovascular magnetic resonance, the 3D time-resolved phase-contrast technique, also known as 4D flow, is gaining increasing attention due to applications that exploit three-directional velocity encoding throughout the cardiac cycle. Blood flow volume assessment usually requires an expert to draw regions of interest (ROI) around the vessel cross section, whereas the errors involved in this estimation have not been thoroughly investigated. Our objective is to quantify the influence of ROI sizing, angulation and spatial resolution of the reconstructed plane employed in blood flow measurements using 4D flow.Approach.Three circular ROIs were drawn around the ascending, arch and descending aorta of healthy volunteers (n= 27) and patients with a dilated ascending aorta or bicuspid valve (n= 37). We applied systematic changes of ROI diameter (up to ±10%), tilt angle (up to ±25°) and spatial resolution (from 0.25 to 2 mm) of the reconstructed oblique planes, calculating the effects on net, forward and backward blood flow volumes.Main results.Patients had a larger ascending aorta than healthy volunteers with similar ages and male sex proportion (60 ± 15 y.o. vs 58 ± 16 y.o. and 84% vs 70%, respectively). Higher forward and backward flow volumes were observed in the ascending aorta and the aortic arch of the patients with respect to controls (p< 0.001), whereas net volumes were similar: 74.0 ± 20.8 ml versus 75.7 ± 21.8 ml (p= 0.37), respectively. The ascending aorta was the most sensitive to ROI modifications. Changes of ±10% in the ROI diameter and ±25° in tilt angles produced flow volume differences of up to 9 ml (10%) and 18 ml (15%) in controls and patients, respectively. Modifying the reconstructed planes spatial resolution produced flow volume changes below 2 ml.Significance.Since the setting of the ROI size and plane angle could produce errors that represent up to 20% of the forward and/or backward aortic flow volume, a good standardization for vessel segmentation and plane positioning is desirable.
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Affiliation(s)
- M E Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - A F Pascaner
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - F N Guilenea
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - J Alcibar
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
| | - U Gencer
- Cardiovascular Imaging Unit, Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
| | - G Soulat
- Cardiovascular Imaging Unit, Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
| | - E Mousseaux
- Cardiovascular Imaging Unit, Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
| | - D Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Solís 453, CP 1078 Buenos Aires, Argentina
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74
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Nakaza M, Matsumoto M, Sekine T, Inoue T, Ando T, Ogawa M, Obara M, Leonowicz O, Kumita S, Usuda J. Dual-VENC 4D Flow MRI Can Detect Abnormal Blood Flow in the Left Atrium That Potentially Causes Thrombosis Formation after Left Upper Lobectomy. Magn Reson Med Sci 2021; 21:433-443. [PMID: 33790138 PMCID: PMC9316132 DOI: 10.2463/mrms.mp.2020-0170] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose of the current study was to clarify the blood flow pattern in the left atrium (LA), potentially causing the formation of thrombosis after left upper lobectomy (LUL). The blood flow in the LA was evaluated and compared between LUL patients with and without thrombosis. For the evaluation, we applied highly accelerated 4D flow MRI with dual-velocity encoding (VENC) scheme, which was expected to be able to capture slow flow components in the LA accurately. Methods: Eight volunteers and 18 patients subjected to LUL underwent dual-VENC 4D Flow MRI. Eight patients had a history of thrombosis. We measured the blood flow velocity and stasis ratio (proportion in the volume that did not exceed 10 cm/s in any cardiac phase) in the LA and left superior pulmonary vein (LSPV) stump. For visual assessment, the presence of each collision of the blood flow from pulmonary veins and vortex flow in the LA were evaluated. Each acquired value was compared between healthy participants and LUL patients, and in LUL patients with and without thrombosis. Results: In LUL patients, blood flow velocity near the inflow part of the left superior pulmonary vein (Lt Upp) and mean velocity in the LA were lower, and stasis ratio in the LA was higher compared with healthy volunteers (Lt Upp 9.10 ± 3.09 vs.13.23 ± 14.19 cm/s, mean velocity in the LA 9.81 ± 2.49 vs. 11.40 ± 1.15 cm/s, and stasis ratio 25.28 ± 18.64 vs. 4.71 ± 3.03%, P = 0.008, 0.037, and < 0.001). There was no significant difference in any quantification values between LUL patients with and without thrombosis. For visual assessment, the thrombus formation was associated with no collision pattern (62.5% vs. 10%, P = 0.019) and not with vortex flow pattern (50% vs. 30%, P = 0.751). Conclusion: The net blood flow velocity was not associated with the thrombus formation. In contrast, a specific blood flow pattern, the absence of blood flow collision from pulmonary veins, correlates to the thrombus formation in the LA.
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Affiliation(s)
| | | | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School.,Department of Radiology, Nippon Medical School Musashi Kosugi Hopital
| | - Tatsuya Inoue
- Department of Respiratory Surgery, Nippon Medical School
| | | | | | | | | | | | - Jitsuo Usuda
- Department of Respiratory Surgery, Nippon Medical School
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75
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Canan A, Ashwath R, Agarwal PP, François C, Rajiah P. Multimodality Imaging of Transposition of the Great Arteries. Radiographics 2021; 41:338-360. [PMID: 33481689 DOI: 10.1148/rg.2021200069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transposition of the great arteries (TGA) is a congenital conotruncal abnormality characterized by discordant connections between the ventricles and great arteries, with the aorta originating from the right ventricle (RV), and the pulmonary artery (PA) originating from the left ventricle (LV). The two main types of TGA are complete transposition or dextro-transposition of the great arteries (D-TGA), commonly referred to as d-loop, and congenitally corrected transposition (CCTGA), commonly referred to as l-loop or L-TGA. In D-TGA, the connections between the ventricles and atria are concordant, whereas in CCTGA they are discordant, with the left atrium connected to the RV, and the right atrium connected to the LV. D-TGA manifests during the neonatal period and can be surgically managed by atrial switch operation (AtrSO), arterial switch operation (ASO), Rastelli procedure, or Nikaidoh procedure. Arrhythmia, systemic ventricular dysfunction, baffle stenosis, and baffle leak are the common complications of AtrSO, whereas supravalvular pulmonary or branch PA stenosis, neoaortic dilatation, and coronary artery narrowing are the common complications of ASO. CCTGA may manifest late in life, even in adulthood. Surgeries for associated lesions such as tricuspid regurgitation, subpulmonic stenosis, and ventricular septal defect may be performed. A double-switch operation that includes both the atrial and arterial switch operations constitutes anatomic correction for CCTGA. Imaging plays an important role in the evaluation of TGA, both before and after surgery, for helping define the anatomy, quantify hemodynamics, and evaluate complications. Transthoracic echocardiography is the first-line imaging modality for presurgical planning in children with TGA. MRI provides comprehensive morphologic and functional information, particularly in adults after surgery. CT is performed when MRI is contraindicated or expected to generate artifacts. The authors review the imaging appearances of TGA, with a focus on pre- and postsurgical imaging. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Ravi Ashwath
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Prachi P Agarwal
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Christopher François
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
| | - Prabhakar Rajiah
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.)
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Riedel C, Lenz A, Fischer L, Li J, Piecha F, Kluwe J, Adam G, Bannas P. Abdominal Applications of 4D Flow MRI. ROFO-FORTSCHR RONTG 2020; 193:388-398. [PMID: 33264806 DOI: 10.1055/a-1271-7405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Four-dimensional flow magnetic resonance imaging (4D flow MRI) provides volumetric and time-resolved visualization and quantification of blood flow. This review presents an overview of possible applications of 4D flow MRI for non-invasive assessment of abdominal hemodynamics. METHOD This review is based on the authors' experience and the current literature. A PubMed database literature research was performed in December 2019 focusing on abdominal applications of 4D flow MRI. We illustrated the review with exemplary figures and movies of clinical cases from our institution. RESULTS AND CONCLUSION 4D flow MRI offers the possibility of comprehensive assessment of abdominal blood flows in different vascular territories and organ systems. Results of recent studies indicate that 4D flow MRI improves understanding of altered hemodynamics in patients with abdominal disease and may be useful for monitoring therapeutic response. Future studies with larger cohorts aiming to integrate 4D flow MRI in the clinical routine setting are needed. KEY POINTS · 4D flow MRI enables comprehensive visualization of the complex abdominal vasculature. · 4D flow MRI enables quantification of abdominal blood flow velocities and flow rates. · 4D flow MRI may enable deeper understanding of altered hemodynamics in abdominal disease. · Further validation studies are needed prior to broad distribution of abdominal 4D flow MRI. CITATION FORMAT · Riedel C, Lenz A, Fischer L et al. Abdominal Applications of 4D Flow MRI. Fortschr Röntgenstr 2021; 193: 388 - 398.
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Affiliation(s)
- Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Li
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Feilix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Kluwe
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wentland AL. Editorial for "Reproducibility of Aorta Segmentation on 4D Flow MRI in Healthy Volunteers". J Magn Reson Imaging 2020; 53:1280-1281. [PMID: 33135303 DOI: 10.1002/jmri.27432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Andrew L Wentland
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
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78
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A test-retest multisite reproducibility study of cardiovascular four-dimensional flow MRI without respiratory gating. Clin Radiol 2020; 76:236.e1-236.e8. [PMID: 33077153 DOI: 10.1016/j.crad.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
AIM To systematically investigate the multisite reproducibility, test-retest reliability, and observer variability of non-respiratory-gated four-dimensional (4D) flow magnetic resonance imaging (MRI) in the thoracic great vessels for the assessment of blood flow and peak velocity. MATERIALS AND METHODS Electrocardiogram (ECG)-gated 4D flow MRI data were acquired without respiratory gating in 10 healthy volunteers. To analyse multisite reproducibility, 4D flow was scanned at three different sites using a 3 T GE MRI machine with identical protocols for the group of participants. In addition, to evaluate test-retest reliability, the same volunteers were scanned in each centre during a second visit. Data analysis included calculation of peak systolic velocity and time-resolved and total flow of both the ascending aorta and pulmonary artery. Two observers conducted the above measurements to assess the interobserver variability. RESULTS Multisite, test-retest, interobserver agreement were good for the calculation of total flow and peak systolic velocity (mean differences <10% of the average flow parameter). CONCLUSION Non-respiratory-gated 4D MRI-based assessment of aortic and pulmonary blood flow can be performed with good reproducibility. It may facilitate the potential clinical application of this technique.
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Umehara T, Takumi K, Ueda K, Tokunaga T, Harada-Takeda A, Suzuki S, Sato M. Four-dimensional flow magnetic resonance imaging study to explain high prevalence of pulmonary vein stump thrombus after left upper lobectomy. J Thorac Dis 2020; 12:5542-5551. [PMID: 33209387 PMCID: PMC7656367 DOI: 10.21037/jtd-20-1606] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Pulmonary vein (PV) stump thrombus, a known source of cerebral infarction, develops almost exclusively after left upper lobectomy; however, the mechanism remains unclear. We therefore evaluated the hemodynamics in the left atrium with four-dimensional flow magnetic resonance imaging (4D-flow MRI), which enables the simultaneous depiction of blood flow at three locations and the evaluation of hemodynamics. Methods 4D-flow MRI was basically performed 7 days after lobectomy for cancer arising in the right upper lobe (n=11), right lower lobe (n=8), left upper lobe (n=13), or left lower lobe (n=8). We evaluated dynamic blood movement from the ipsilateral remaining PV, the resected PV stump, and the contralateral PVs into the left atrium using 4D-flow MRI. Results There were some characteristic blood flow patterns that seemed to either promote or prevent PV stump thrombus. Promotive flow patterns were significantly more frequent and preventive flow patterns were significantly less frequent in patients who had undergone left upper lobectomy than in those who had undergone other lobectomy. Accordingly, the degree of blood turbulence near the vein stump, as measured by the extent of change in the blood movement, was significantly higher in patients who had undergone left upper lobectomy than in patients who had undergone other lobectomy. Conclusions Our study revealed that left upper lobectomy likely causes blood turbulence near the vein stump through complicated blood streams in the left atrium, which can play a part in the development of vein stump thrombus. Further study to identify patients at high risk of vein stump thrombus is warranted.
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Affiliation(s)
- Tadashi Umehara
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Kazuhiro Ueda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Takuya Tokunaga
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Aya Harada-Takeda
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Soichi Suzuki
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan
| | - Masami Sato
- Department of General Thoracic Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, Japan
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Catapano F, Pambianchi G, Cundari G, Rebelo J, Cilia F, Carbone I, Catalano C, Francone M, Galea N. 4D flow imaging of the thoracic aorta: is there an added clinical value? Cardiovasc Diagn Ther 2020; 10:1068-1089. [PMID: 32968661 DOI: 10.21037/cdt-20-452] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Four-dimensional (4D) flow MRI has emerged as a powerful non-invasive technique in cardiovascular imaging, enabling to analyse in vivo complex flow dynamics models by quantifying flow parameters and derived features. Deep knowledge of aortic flow dynamics is fundamental to better understand how abnormal flow patterns may promote or worsen vascular diseases. In the perspective of an increasingly personalized and preventive medicine, growing interest is focused on identifying those quantitative functional features which are early predictive markers of pathological evolution. The thoracic aorta and its spectrum of diseases, as the first area of application and development of 4D flow MRI and supported by an extensive experimental validation, represents the ideal model to introduce this technique into daily clinical practice. The purpose of this review is to describe the impact of 4D flow MRI in the assessment of the thoracic aorta and its most common affecting diseases, providing an overview of the actual clinical applications and describing the potential role of derived advanced hemodynamic measures in tailoring follow-up and treatment.
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Affiliation(s)
- Federica Catapano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.,Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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81
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Joshi A, Ghadimi Mahani M, Dorfman A, Balasubramanian S. Cardiac MR Evaluation of Repaired Tetralogy of Fallot. Semin Roentgenol 2020; 55:290-300. [PMID: 32859345 DOI: 10.1053/j.ro.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aparna Joshi
- Department of Radiology, Section of Pediatric Radiology, Michigan Medicine, Ann Arbor, MI.
| | - Maryam Ghadimi Mahani
- Department of Radiology, Section of Pediatric Radiology and Division of Cardiothoracic Radiology, Michigan Medicine, Ann Arbor, MI
| | - Adam Dorfman
- Department of Pediatrics, Division of Pediatric Cardiology, Michigan Medicine, Ann Arbor, MI
| | - Sowmya Balasubramanian
- Department of Pediatrics, Division of Pediatric Cardiology, Michigan Medicine, Ann Arbor, MI
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82
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Urmeneta Ulloa J, Álvarez Vázquez A, Martínez de Vega V, Cabrera JÁ. Evaluation of Cardiac Shunts With
4D
Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability. J Magn Reson Imaging 2020; 52:1055-1063. [DOI: 10.1002/jmri.27158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Javier Urmeneta Ulloa
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Ana Álvarez Vázquez
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Vicente Martínez de Vega
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - José Ángel Cabrera
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
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83
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Ludwig DR, Shetty AS, Broncano J, Bhalla S, Raptis CA. Magnetic Resonance Angiography of the Thoracic Vasculature: Technique and Applications. J Magn Reson Imaging 2020; 52:325-347. [PMID: 32061029 DOI: 10.1002/jmri.27067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance angiography (MRA) is a powerful clinical tool for evaluation of the thoracic vasculature. MRA can be performed on nearly any magnetic resonance imaging (MRI) scanner, and provides images of high diagnostic quality without the use of ionizing radiation. While computed tomographic angiography (CTA) is preferred in the evaluation of hemodynamically unstable patients, MRA represents an important tool for evaluation of the thoracic vasculature in stable patients. Contrast-enhanced MRA is generally performed unless there is a specific contraindication, as it shortens the duration of the exam and provides images of higher diagnostic quality than noncontrast MRA. However, intravenous contrast is often not required to obtain a diagnostic evaluation for most clinical indications. Indeed, a variety of noncontrast MRA techniques are used for thoracic imaging, often in conjunction with contrast-enhanced MRA, each of which has a differing degree of reliance on flowing blood to produce the desired vascular signal. In this article we review contrast-enhanced MRA, with a focus on contrast agents, methods of bolus timing, and considerations in imaging acquisition. Next, we cover the mechanism of contrast, strengths, and weaknesses of various noncontrast MRA techniques. Finally, we present an approach to protocol development and review representative protocols used at our institution for a variety of thoracic applications. Further attention will be devoted to additional techniques employed to address specific clinical questions, such as delayed contrast-enhanced imaging, provocative maneuvers, electrocardiogram and respiratory gating, and phase-contrast imaging. The purpose of this article is to review basic techniques and methodology in thoracic MRA, discuss an approach to protocol development, and illustrate commonly encountered pathology on thoracic MRA examinations. Level of Evidence 5 Technical Efficacy Stage 3.
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Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jordi Broncano
- Cardiothoracic Imaging Section, Health Time, Hospital de la Cruz Roja and San Juan de Dios, Cordoba, Spain
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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84
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de Lange C. Imaging of complications following Fontan circulation in children - diagnosis and surveillance. Pediatr Radiol 2020; 50:1333-1348. [PMID: 32468285 PMCID: PMC7445207 DOI: 10.1007/s00247-020-04682-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
Abstract
The Fontan operation is performed for various cardiac lesions with single-ventricle physiology. The survival rate of Fontan patients is increasing for adolescents and young adults, with an expected 30-year survival of >80%. Medical health care providers including specialists in organ systems and pediatric radiologists need to improve their knowledge about the Fontan circulation and the various organ complications to monitor care. In this review the author explains the basic anatomical and functional features of Fontan palliation and gives an overview of the multiple long-term organ complications that might present in the pediatric population. These include decreased physical capacity, ventricular dysfunction, atrioventricular valve regurgitation and arrhythmia, as well as protein-losing enteropathy, plastic bronchitis, growth/bone composition disturbances, renal dysfunction, and the recently recognized and important liver fibrosis (Fontan-associated liver disease). Neuropsychological and behavioral deficits occur frequently. This review focuses on the key role of radiology in making the diagnosis of these complications, monitoring therapy and predicting outcomes in the pediatric age group. The author discusses how and when radiology is important in Fontan patients, as well as how new techniques enabling quantitative measures in imaging with US, MRI and CT are adapted for pediatric use, and how they contribute to urgently needed surveillance strategies.
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Affiliation(s)
- Charlotte de Lange
- Department of Radiology and Clinical Physiology, Queen Silvia Children's Hospital, Rondv.10, S-41516, Gothenburg, Sweden. .,Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
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Sergio P, Miceli A. 4D-Flow MRI: Beyond the Images. Semin Thorac Cardiovasc Surg 2019; 32:35. [PMID: 31550498 DOI: 10.1053/j.semtcvs.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Pietro Sergio
- Department of Radiology, Ospedale Maggiore di Cremona, Cremona, Italy
| | - Antonio Miceli
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio, Milano, Italy.
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87
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Choe YH. Vena Caval Flow Regurgitation at Four-dimensional Flow MRI: A New Sign for a Hemodynamic Phenotype of Chronic Obstructive Pulmonary Disease and Emphysema? Radiology 2019; 292:595-596. [DOI: 10.1148/radiol.2019191255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yeon Hyeon Choe
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Korea
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Ordovas K. Invited Commentary on “Four-dimensional Flow MRI,” with Response from Dr Azarine et al. Radiographics 2019; 39:648-650. [DOI: 10.1148/rg.2019190035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Karen Ordovas
- Department of Radiology, University of California, San Francisco San Francisco, California
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