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The Role of Cardiac Magnetic Resonance in Aortic Stenosis and Regurgitation. J Cardiovasc Dev Dis 2022; 9:jcdd9040108. [PMID: 35448084 PMCID: PMC9030119 DOI: 10.3390/jcdd9040108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [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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Webber M, Falconer D, AlFarih M, Joy G, Chan F, Davie C, Hamill Howes L, Wong A, Rapala A, Bhuva A, Davies RH, Morton C, Aguado-Sierra J, Vazquez M, Tao X, Krausz G, Tanackovic S, Guger C, Xue H, Kellman P, Pierce I, Schott J, Hardy R, Chaturvedi N, Rudy Y, Moon JC, Lambiase PD, Orini M, Hughes AD, Captur G. Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development. BMC Cardiovasc Disord 2022; 22:140. [PMID: 35365075 PMCID: PMC8972905 DOI: 10.1186/s12872-022-02582-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD. METHODS We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. DISCUSSION By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).
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Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Mashael AlFarih
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Clare Davie
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Lee Hamill Howes
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anish Bhuva
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Institute of Health Informatics, UCL, Euston Road, London, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | | | - Jazmin Aguado-Sierra
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Mariano Vazquez
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Xuyuan Tao
- École Nationale Supérieure Des Arts Et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix Cedex 1, France
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Nishi Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Yang K, Wu S, Ghista DN, Yang D, Wong KKL. Automated vortex identification based on Lagrangian averaged vorticity deviation in analysis of blood flow in the atrium from phase contrast MRI. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 216:106678. [PMID: 35144147 DOI: 10.1016/j.cmpb.2022.106678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To present and validate a method for automated identification of the Lagrangian vortices and Eulerian vortices for analyzing flow within the right atrium (RA), from phase contrast magnetic resonance imaging (PC-MRI) data. METHODOLOGY Our proposed algorithm characterizes the trajectory integral associated with vorticity deviation and the spatial mean of vortex rings, for the Lagrangian averaged vorticity deviation (LAVD) based identification and tracking of vortex rings within the heart chamber. For this purpose, the optical flow concept was adopted to interpolate the time frames between larger discrete frames, to minimize the error caused by constructing a continuous velocity field for the integral process of LAVD. Then the Hough transform was used to automatically extract the vortex regions of interest. The computed flow data within the RA of the participants' hearts was then used to validate the performance of our proposed method. RESULTS In the paper, illustrations are provided for derived evolution of Euler vortices and Lagrangian vortices of a healthy subject. The visualization results have shown that our proposed method can accurately identify the Euler vortices and Lagrangian vortices, in the context of measuring the vorticity and vortex volume of the vortices within the RA chamber. Then the employment of Hough transform-based automated vortex extraction has improved the robustness and scalability of the LAVD in identifying cardiac vortices. The analytical results have demonstrated that the introduction of the Horn-Schunck optical flow can more accurately synthesize the intermediate PC-MRI to construct a continuous velocity field, compared with other interpolation methods. CONCLUSION A novel analytical framework has been developed to accurately identify the flow vortices in the RA chamber based on Horn-Schunck optical flow and Hough transform. From the obtained analytical study results, the development and changes of dominant vortices within this cardiac chamber during the cardiac cycle can be acquired. This can provide to cardiologists a deeper understanding of the hemodynamics within the heart chambers.
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Affiliation(s)
- Ke Yang
- Key Laboratory of Metallurgical Equipment and Control Technology, Ministry of Education, Wuhan University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Mechanical Transmission and Manufacturing Engineering, Wuhan University of Science and Technology, Wuhan, China.
| | - Shiqian Wu
- School of Information Science and Engineering, Wuhan University of Science and Technology, Wuhan, China.
| | | | - Di Yang
- Key Laboratory of Metallurgical Equipment and Control Technology, Ministry of Education, Wuhan University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Mechanical Transmission and Manufacturing Engineering, Wuhan University of Science and Technology, Wuhan, China.
| | - Kelvin K L Wong
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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154
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Trenti C, Ziegler M, Bjarnegård N, Ebbers T, Lindenberger M, Dyverfeldt P. Wall shear stress and relative residence time as potential risk factors for abdominal aortic aneurysms in males: a 4D flow cardiovascular magnetic resonance case-control study. J Cardiovasc Magn Reson 2022; 24:18. [PMID: 35303893 PMCID: PMC8932193 DOI: 10.1186/s12968-022-00848-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysms (AAA) can lead to catastrophic events such as dissection or rupture, and are an expression of general aortic disease. Low wall shear stress (WSS), high oscillatory shear index (OSI), and high relative residence time (RRT) have been correlated against increased uptake of inflammatory markers in the vessel wall and may improve risk stratification of AAA. We sought to obtain a comprehensive view of WSS, OSI, and RRT in the whole aorta for patients with AAA and age-matched elderly controls and young normal controls. METHODS 4D Flow cardiovascular magnetic resonance images of the whole aorta were acquired in 18 AAA patients (70.8 ± 3.4 years), 22 age-matched controls (71.4 ± 3.4 years), and 23 young subjects (23.3 ± 3.1 years), all males. Three-dimensional segmentations of the whole aorta were created for all timeframes using a semi-automatic approach. The aorta was divided into five segments: ascending aorta, arch, descending aorta, suprarenal and infrarenal abdominal aorta. For each segment, average values of peak WSS, OSI, and RRT were computed. Student's t-tests were used to compare values between the three cohorts (AAA patients vs elderly controls, and elderly controls vs young controls) where the data were normally distributed, and the non-parametric Wilcoxon rank sum tests were used otherwise. RESULTS AAA patients had lower peak WSS in the descending aorta as well as in the abdominal aorta compared to elderly controls (p ≤ 0.001), similar OSI, but higher RRT in the descending and abdominal aorta (p ≤ 0.001). Elderly controls had lower peak WSS compared to young controls throughout the aorta (p < 0.001), higher OSI in all segments except for the infrarenal aorta (p < 0.001), and higher RRT throughout the aorta, except the infrarenal aorta (p < 0.001). CONCLUSIONS This study provides novel insights into WSS, OSI, and RRT in patients with AAA in relation to normal ageing, highlighting how AAA patients have markedly abnormal hemodynamic stresses not only in the infrarenal, but in the entire aorta. Moreover, we identified RRT as a marker for abnormal AAA hemodynamics. Further investigations are needed to explore if RRT or other measures of hemodynamics stresses best predict AAA growth and/or rupture.
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Affiliation(s)
- Chiara Trenti
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Magnus Ziegler
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Niclas Bjarnegård
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Marcus Lindenberger
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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155
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Herthum H, Carrillo H, Osses A, Uribe S, Sack I, Bertoglio C. Multiple motion encoding in phase-contrast MRI: A general theory and application to elastography imaging. Med Image Anal 2022; 78:102416. [PMID: 35334444 DOI: 10.1016/j.media.2022.102416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/23/2021] [Accepted: 03/01/2022] [Indexed: 01/04/2023]
Abstract
While MRI allows to encode the motion of tissue in the magnetization's phase, it remains yet a challenge to obtain high fidelity motion images due to wraps in the phase for high encoding efficiencies. Therefore, we propose an optimal multiple motion encoding method (OMME) and exemplify it in Magnetic Resonance Elastography (MRE) data. OMME is formulated as a non-convex least-squares problem for the motion using an arbitrary number of phase-contrast measurements with different motion encoding gradients (MEGs). The mathematical properties of OMME are proved in terms of standard deviation and dynamic range of the motion's estimate for arbitrary MEGs combination which are confirmed using synthetically generated data. OMME's performance is assessed on MRE data from in vivo human brain experiments and compared to dual encoding strategies. The unwrapped images are further used to reconstruct stiffness maps and compared to the ones obtained using conventional unwrapping methods. OMME allowed to successfully combine several MRE phase images with different MEGs, outperforming dual encoding strategies in either motion-to-noise ratio (MNR) or number of successfully reconstructed voxels with good noise stability. This lead to stiffness maps with greater resolution of details than obtained with conventional unwrapping methods. The proposed OMME method allows for a flexible and noise robust increase in the dynamic range and thus provides wrap-free phase images with high MNR. In MRE, the method may be especially suitable when high resolution images with high MNR are needed.
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Affiliation(s)
- Helge Herthum
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitt zu Berlin, and Berlin Institute of Health, Berlin, 10117, Germany
| | - Hugo Carrillo
- Center for Mathematical Modeling, Universidad de Chile, Santiago, 8370456, Chile; Bernoulli Institute, University of Groningen, Groningen, 9747AG, the Netherlands
| | - Axel Osses
- Center for Mathematical Modeling, Universidad de Chile, Santiago, 8370456, Chile; Department of Mathematical Engineering, Universidad de Chile, Santiago, 8370456, Chile; ANID - Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile; ANID - Millenium Nucleus in Applied Control and Inverse Problems ACIP, Santiago, 7820436, Chile
| | - Sergio Uribe
- ANID - Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile; Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, 7820436, Chile
| | - Ingolf Sack
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitt zu Berlin, and Berlin Institute of Health, Berlin, 10117, Germany
| | - Cristóbal Bertoglio
- Bernoulli Institute, University of Groningen, Groningen, 9747AG, the Netherlands.
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156
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Noninvasive Cardiac Imaging in Formerly Preeclamptic Women for Early Detection of Subclinical Myocardial Abnormalities: A 2022 Update. Biomolecules 2022; 12:biom12030415. [PMID: 35327607 PMCID: PMC8946283 DOI: 10.3390/biom12030415] [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: 02/01/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Preeclampsia is a maternal hypertensive disease, complicating 2–8% of all pregnancies. It has been linked to a 2–7-fold increased risk for the development of cardiovascular disease, including heart failure, later in life. A total of 40% of formerly preeclamptic women develop preclinical heart failure, which may further deteriorate into clinical heart failure. Noninvasive cardiac imaging could assist in the early detection of myocardial abnormalities, especially in the preclinical stage, when these changes are likely to be reversible. Moreover, imaging studies can improve our insights into the relationship between preeclampsia and heart failure and can be used for monitoring. Cardiac ultrasound is used to assess quantitative changes, including the left ventricular cavity volume and wall thickness, myocardial mass, systolic and diastolic function, and strain. Cardiac magnetic resonance imaging may be of additional diagnostic value to assess diffuse and focal fibrosis and perfusion. After preeclampsia, sustained elevated myocardial mass along with reduced myocardial circumferential and longitudinal strain and decreased diastolic function is reported. These findings are consistent with the early phases of heart failure, referred to as preclinical (asymptomatic) or B-stage heart failure. In this review, we will provide an up-to-date overview of the potential of cardiac magnetic resonance imaging and echocardiography in identifying formerly preeclamptic women who are at high risk for developing heart failure. The potential contribution to early cardiac screening of women with a history of preeclampsia and the pros and cons of these imaging modalities are outlined. Finally, recommendations for future research are presented.
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157
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Ota H, Kamada H, Higuchi S, Takase K. Clinical Application of 4D Flow MR Imaging to Pulmonary Hypertension. Magn Reson Med Sci 2022; 21:309-318. [PMID: 35185084 PMCID: PMC9680544 DOI: 10.2463/mrms.rev.2021-0111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/19/2021] [Indexed: 10/14/2023] Open
Abstract
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure (PAP). Although right-heart catheterization is the gold standard method for the diagnosis of PH by definition, various less-invasive imaging tests have been used for screening, detection of underlying diseases-causing PH, and monitoring of diseases. Among them, 4D flow MRI is an emerging and unique imaging test that allows for comprehensive visualization of blood flow in the right heart and proximal pulmonary arteries. The characteristic blood flow pattern observed in patients with PH is vortical flow formation in the main pulmonary artery. Recent studies have proposed the use of these findings to determine not only the presence of PH but also estimate the mean PAP. Other applications of 4D flow MRI for PH include measurement of wall shear stress, helicity, and 3D flow balance in the pulmonary arteries. It is worth noting that 4D flow has also the potential for longitudinal follow-ups. In this review, the clinical definition of PH, summary of conventional imaging tests, characteristics of pulmonary arterial flow as shown by 4D flow MRI, and clinical application of 4D flow MRI in the management of patients with PH will be discussed.
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Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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158
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Oechtering TH, Roberts GS, Panagiotopoulos N, Wieben O, Reeder SB, Roldán-Alzate A. Clinical Applications of 4D Flow MRI in the Portal Venous System. Magn Reson Med Sci 2022; 21:340-353. [PMID: 35082218 PMCID: PMC9680553 DOI: 10.2463/mrms.rev.2021-0105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/13/2021] [Indexed: 09/27/2023] Open
Abstract
Evaluation of the hemodynamics in the portal venous system plays an essential role in many hepatic pathologies. Changes in portal flow and vessel morphology are often indicative of disease.Routinely used imaging modalities, such as CT, ultrasound, invasive angiography, and MRI, often focus on either hemodynamics or anatomical imaging. In contrast, 4D flow MRI facilitiates a more comprehensive understanding of pathophysiological mechanisms by simultaneously and noninvasively acquiring time-resolved flow and anatomical information in a 3D imaging volume.Though promising, 4D flow MRI in the portal venous system is especially challenging due to small vessel calibers, slow flow velocities, and breathing motion. In this review article, we will discuss how to account for these challenges when planning and conducting 4D flow MRI acquisitions in the upper abdomen. We will address patient preparation, sequence acquisition, postprocessing, quality control, and analysis of 4D flow data.In the second part of this article, we will review potential clinical applications of 4D flow MRI in the portal venous system. The most promising area for clinical utilization is the diagnosis and grading of liver cirrhosis and its complications. Relevant parameters acquired by 4D flow MRI include the detection of reduced or reversed flow in the portal venous system, characterization of portosystemic collaterals, and impaired response to a meal challenge. In patients with cirrhosis, 4D flow MRI has the potential to address the major unmet need of noninvasive detection of gastroesophageal varices at high risk for bleeding. This could replace many unnecessary, purely diagnostic, and invasive esophagogastroduodenoscopy procedures, thereby improving patient compliance with follow-up. Moreover, 4D flow MRI offers unique insights and added value for surgical planning and follow-up of multiple hepatic interventions, including transjugular intrahepatic portosystemic shunts, liver transplantation, and hepatic disease in children. Lastly, we will discuss the path to clinical implementation and remaining challenges.
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Affiliation(s)
- Thekla H. Oechtering
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Radiology, Universität zu Lübeck, Luebeck, Germany
| | - Grant S. Roberts
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Nikolaos Panagiotopoulos
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Radiology, Universität zu Lübeck, Luebeck, Germany
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Scott B. Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Emergency, University of Wisconsin Medicine, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
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159
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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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160
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Isoda H, Fukuyama A. Quality Control for 4D Flow MR Imaging. Magn Reson Med Sci 2022; 21:278-292. [PMID: 35197395 PMCID: PMC9680545 DOI: 10.2463/mrms.rev.2021-0165] [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: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 01/06/2023] Open
Abstract
In recent years, 4D flow MRI has become increasingly important in clinical applications for the blood vessels in the whole body, heart, and cerebrospinal fluid. 4D flow MRI has advantages over 2D cine phase-contrast (PC) MRI in that any targeted area of interest can be analyzed post-hoc, but there are some factors to be considered, such as ensuring measurement accuracy, a long imaging time and post-processing complexity, and interobserver variability.Due to the partial volume phenomenon caused by low spatial and temporal resolutions, the accuracy of flow measurement in 4D flow MRI is reduced. For spatial resolution, it is recommended to include at least four voxels in the vessel of interest, and if possible, six voxels. In large vessels such as the aorta, large voxels can be secured and SNR can be maintained, but in small cerebral vessels, SNR is reduced, resulting in reduced accuracy. A temporal resolution of less than 40 ms is recommended. The velocity-to-noise ratio (VNR) of low-velocity blood flow is low, resulting in poor measurement accuracy. The use of dual velocity encoding (VENC) or multi-VENC is recommended to avoid velocity wrap around and to increase VNR. In order to maintain sufficient spatio-temporal resolution, a longer imaging time is required, leading to potential patient movement during examination and a corresponding decrease in measurement accuracy.For the clinical application of new technologies, including various acceleration techniques, in vitro and in vivo accuracy verification based on existing accuracy-validated 2D cine PC MRI and 4D flow MRI, as well as accuracy verification on the conservation of mass' principle, should be performed, and intraobserver repeatability, interobserver reproducibility, and test-retest reproducibility should be checked.
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Affiliation(s)
- Haruo Isoda
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Biomedical Imaging Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Atsushi Fukuyama
- Faculty of Health Sciences, Department of Radiological Sciences, Japan Healthcare University, Sapporo, Hokkaido, Japan
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161
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Corrado PA, Wentland AL, Starekova J, Dhyani A, Goss KN, Wieben O. Fully automated intracardiac 4D flow MRI post-processing using deep learning for biventricular segmentation. Eur Radiol 2022; 32:5669-5678. [PMID: 35175379 DOI: 10.1007/s00330-022-08616-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES 4D flow MRI allows for a comprehensive assessment of intracardiac blood flow, useful for assessing cardiovascular diseases, but post-processing requires time-consuming ventricular segmentation throughout the cardiac cycle and is prone to subjective errors. Here, we evaluate the use of automatic left and right ventricular (LV and RV) segmentation based on deep learning (DL) network that operates on short-axis cine bSSFP images. METHODS A previously published DL network was fine-tuned via retraining on a local database of 106 subjects scanned at our institution. In 26 test subjects, the ventricles were segmented automatically by the network and manually by 3 human observers on bSSFP MRI. The bSSFP images were then registered to the corresponding 4D flow images to apply the segmentation to 4D flow velocity data. Dice coefficients and the relative deviation between measurements (automatic vs. manual and interobserver manual) of various hemodynamic parameters were assessed. RESULTS The automated segmentation resulted in similar Dice scores (LV: 0.92, RV: 0.86) and lower relative deviations from manual segmentation in left ventricular (LV) average kinetic energy (KE) (8%) and RV KE (15%) than the Dice scores (LV: 0.91, RV: 0.87) and relative deviations between manual segmentation observers (LV KE: 11%, p = 0.01; RV KE: 19%, p = 0.03). CONCLUSIONS The automated post-processing method using deep learning resulted in hemodynamic measurements that differ from a manual observer's measurements equally or less than the variation between manual observers. This approach can be used to decrease post-processing time on intraventricular 4D flow data and mitigate interobserver variability. KEY POINTS • Our proposed method allows for fully automated post-processing of intraventricular 4D flow MRI data. • Our method resulted in hemodynamic measurements that matched those derived from manual segmentation equally as well as interobserver variability. • Our method can be used to greatly accelerate intraventricular 4D flow post-processing and improve interobserver repeatability.
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Affiliation(s)
- Philip A Corrado
- University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA.
| | - Andrew L Wentland
- University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Jitka Starekova
- University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Archana Dhyani
- University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Kara N Goss
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Oliver Wieben
- University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI, 53705, USA
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162
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Itatani K, Sekine T, Yamagishi M, Maeda Y, Higashitani N, Miyazaki S, Matsuda J, Takehara Y. Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications. Magn Reson Med Sci 2022; 21:380-399. [PMID: 35173116 DOI: 10.2463/mrms.rev.2021-0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Blood flow imaging becomes an emerging trend in cardiology with the recent progress in computer technology. It not only visualizes colorful flow velocity streamlines but also quantifies the mechanical stress on cardiovascular structures; thus, it can provide the detailed inspections of the pathophysiology of diseases and predict the prognosis of cardiovascular functions. Clinical applications include the comprehensive assessment of hemodynamics and cardiac functions in echocardiography vector flow mapping (VFM), 4D flow MRI, and surgical planning as a simulation medicine in computational fluid dynamics (CFD).For evaluation of the hemodynamics, novel mathematically derived parameters obtained using measured velocity distributions are essential. Among them, the traditional and typical parameters are wall shear stress (WSS) and its related parameters. These parameters indicate the mechanical damages to endothelial cells, resulting in degenerative intimal change in vascular diseases. Apart from WSS, there are abundant parameters that describe the strength of the vortical and/or helical flow patterns. For instance, vorticity, enstrophy, and circulation indicate the rotating flow strength or power of 2D vortical flows. In addition, helicity, which is defined as the cross-linking number of the vortex filaments, indicates the 3D helical flow strength and adequately describes the turbulent flow in the aortic root in cases with complicated anatomies. For the description of turbulence caused by the diseased flow, there exist two types of parameters based on completely different concepts, namely: energy loss (EL) and turbulent kinetic energy (TKE). EL is the dissipated energy with blood viscosity and evaluates the cardiac workload related to the prognosis of heart failure. TKE describes the fluctuation in kinetic energy during turbulence, which describes the severity of the diseases that cause jet flow. These parameters are based on intuitive and clear physiological concepts, and are suitable for in vivo flow measurements using inner velocity profiles.
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Affiliation(s)
- Keiichi Itatani
- Department of Cardiovascular Surgery, Osaka City University.,Cardio Flow Design Inc
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Norika Higashitani
- Cardio Flow Design Inc.,Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya university Graduate School of Medicine
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163
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Sugiyama M, Takehara Y, Naganawa S. Does the Pulsatile Non-uniform Flow Matter in MR Flowmetry? Magn Reson Med Sci 2022; 21:365-371. [PMID: 35173117 DOI: 10.2463/mrms.rev.2021-0099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
3D cine phase-contrast (4D flow) MRI is a sequence with great potential for non-invasive time-resolved 3D flowmetry at arbitrary vessel sections in various blood vessels. However, it is not widely known that the flowmetry with 4D flow MRI is vulnerable to pulsatile and non-uniform flow. Due to the limited spatial and temporal resolutions, averaging within the 3D voxel is occurring during the flowmetry. A simple solution is to avoid setting the measurement plane in the area where non-uniform flow is dominant, which is possible with an aid of streamline depictions generated by computational fluid dynamics (CFD) or 4D flow MRI data. Unlike 4D flow MRI, flowmetry in CFD simulation can use higher spatial and temporal resolution depending on computer performance; therefore, it is robust to fluctuating non-uniform flow. However, the performance of CFD simulations might be limited due to inlet conditions with low temporal resolution. Difficulty applying complex blood flow such as reflection flow from periphery may also limit accurate simulation. Caution should be taken when comparing the result of CFD simulation to that of 4D flow measurement.
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Affiliation(s)
- Masataka Sugiyama
- Departments of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine.,Departments of Radiology, Nagoya University, Graduate School of Medicine
| | - Yasuo Takehara
- Departments of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine.,Departments of Radiology, Nagoya University, Graduate School of Medicine
| | - Shinji Naganawa
- Departments of Radiology, Nagoya University, Graduate School of Medicine
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164
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Abstract
Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time-resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health. The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain-wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow-up of interventions aiming to restore a normal cerebral circulation. Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest.
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Affiliation(s)
- Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science and Neurosciences, Umeå University, Umeå, Sweden
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165
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Non-contrast magnetic resonance angiography/venography techniques: what are my options? Pediatr Radiol 2022; 52:271-284. [PMID: 33893543 DOI: 10.1007/s00247-021-05067-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/07/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Non-contrast magnetic resonance (MR) angiography and MR venography techniques are gaining popularity for vascular imaging because they are faster, more forgiving and less costly compared with contrast-enhanced MR angiography. Non-contrast MR angiography also avoids gadolinium deposition, which is especially important in imaging children. Non-contrast MR angiography has an array of specific applications for numerous clinical indications. This review summarizes the non-contrast MR angiography methods and their relative advantages and disadvantages. The paper also guides the reader on which technique to consider when determining the optimal imaging modality for each individual patient.
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166
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Alattar Y, Soulat G, Gencer U, Messas E, Bollache E, Kachenoura N, Mousseaux E. Left ventricular diastolic early and late filling quantified from 4D flow magnetic resonance imaging. Diagn Interv Imaging 2022; 103:345-352. [DOI: 10.1016/j.diii.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 01/02/2023]
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167
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Nguyen TQ, Traberg MS, Olesen JB, Moshavegh R, Møller-Sørensen PH, Lönn L, Jensen JA, Nielsen MB, Hansen KL. Pressure Difference Estimation in Non-stenotic Carotid Bifurcation Phantoms Using Vector Flow Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:346-357. [PMID: 34763906 DOI: 10.1016/j.ultrasmedbio.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 08/21/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Local pressure differences estimated using vector flow imaging (VFI) and direct catheterization in seven carotid bifurcation phantoms were compared with simulated pressure fields. VFI correlated strongly with simulated peak pressure differences (r = 0.99, p < 0.00001), with an average overestimation of 12.3 Pa (28.6%). The range between the lowest and highest pressure difference of VFI underestimated simulations by 4.6 Pa (8.06%; r = 0.99, p < 0.0001). The catheter method exhibited no correlation (r = -0.09, p = 0.85). Ten repeated measurements on one phantom revealed a small standard deviation (SD) for VFI (SD = 8.4%, mean estimated SD = 11.5%), but not for the catheter method (SD = 785.6%). An in vivo peak systolic pressure difference of 97.9 Pa (estimated SD = 30%) was measured using VFI in one healthy individual. This study indicates that VFI pressure difference estimation is feasible in phantoms and in vivo and realistic estimates of the SD can be attained from the data.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Sand Traberg
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | | | | | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Michael Bachmann Nielsen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Kristoffer Lindskov Hansen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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168
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Wall Shear Stress Alteration: a Local Risk Factor of Atherosclerosis. Curr Atheroscler Rep 2022; 24:143-151. [PMID: 35080718 DOI: 10.1007/s11883-022-00993-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Wall shear stress describes the mechanical influence of blood flow on the arterial wall. In this review, we discuss the role of the wall shear stress in the development of atherosclerosis and its complications. RECENT FINDINGS Areas with chronically low, oscillating wall shear stress are most prone to plaque development and include outer bifurcation walls and inner walls of arches. In some diseases, patients have lower wall shear stress even in straight arterial segments; also, these findings were associated with atherosclerosis. High wall shear stress develops in the distal part (shoulder) of a stenosis and contributes to plaque destabilization. Wall shear stress changes are involved in the development of atherosclerosis. They are not fully understood yet and act in concert with tangential wall stress.
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169
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Riva A, Sturla F, Pica S, Camporeale A, Tondi L, Saitta S, Caimi A, Giese D, Palladini G, Milani P, Castelvecchio S, Menicanti L, Redaelli A, Lombardi M, Votta E. Comparison of Four-Dimensional Magnetic Resonance Imaging Analysis of Left Ventricular Fluid Dynamics and Energetics in Ischemic and Restrictive Cardiomyopathies. J Magn Reson Imaging 2022; 56:1157-1170. [PMID: 35075711 PMCID: PMC9541919 DOI: 10.1002/jmri.28076] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 01/07/2023] Open
Abstract
Background Time‐resolved three‐directional velocity‐encoded (4D flow) magnetic resonance imaging (MRI) enables the quantification of left ventricular (LV) intracavitary fluid dynamics and energetics, providing mechanistic insight into LV dysfunctions. Before becoming a support to diagnosis and patient stratification, this analysis should prove capable of discriminating between clearly different LV derangements. Purpose To investigate the potential of 4D flow in identifying fluid dynamic and energetics derangements in ischemic and restrictive LV cardiomyopathies. Study Type Prospective observational study. Population Ten patients with post‐ischemic cardiomyopathy (ICM), 10 patients with cardiac light‐chain cardiac amyloidosis (AL‐CA), and 10 healthy controls were included. Field Strength/Sequence 1.5 T/balanced steady‐state free precession cine and 4D flow sequences. Assessment Flow was divided into four components: direct flow (DF), retained inflow, delayed ejection flow, and residual volume (RV). Demographics, LV morphology, flow components, global and regional energetics (volume‐normalized kinetic energy [KEV] and viscous energy loss [ELV]), and pressure‐derived hemodynamic force (HDF) were compared between the three groups. Statistical Tests Intergroup differences in flow components were tested by one‐way analysis of variance (ANOVA); differences in energetic variables and peak HDF were tested by two‐way ANOVA. A P‐value of <0.05 was considered significant. Results ICM patients exhibited the following statistically significant alterations vs. controls: reduced KEV, mostly in the basal region, in systole (−44%) and in diastole (−37%); altered flow components, with reduced DF (−33%) and increased RV (+26%); and reduced basal–apical HDF component on average by 63% at peak systole. AL‐CA patients exhibited the following alterations vs. controls: significantly reduced KEV at the E‐wave peak in the basal segment (−34%); albeit nonstatistically significant, increased peaks and altered time‐course of the HDF basal–apical component in diastole and slightly reduced HDF components in systole. Data Conclusion The analysis of multiple 4D flow‐derived parameters highlighted fluid dynamic alterations associated with systolic and diastolic dysfunctions in ICM and AL‐CA patients, respectively. Level of Evidence 2 Technical Efficacy Stage 3
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Affiliation(s)
- Alessandra Riva
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simone Saitta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandro Caimi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Paolo Milani
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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170
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Elsayed A, Mauger CA, Ferdian E, Gilbert K, Scadeng M, Occleshaw CJ, Lowe BS, McCulloch AD, Omens JH, Govil S, Pushparajah K, Young AA. Right Ventricular Flow Vorticity Relationships With Biventricular Shape in Adult Tetralogy of Fallot. Front Cardiovasc Med 2022; 8:806107. [PMID: 35127866 PMCID: PMC8813860 DOI: 10.3389/fcvm.2021.806107] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Remodeling in adults with repaired tetralogy of Fallot (rToF) may occur due to chronic pulmonary regurgitation, but may also be related to altered flow patterns, including vortices. We aimed to correlate and quantify relationships between vorticity and ventricular shape derived from atlas-based analysis of biventricular shape. Adult rToF (n = 12) patients underwent 4D flow and cine MRI imaging. Vorticity in the RV was computed after noise reduction using a neural network. A biventricular shape atlas built from 95 rToF patients was used to derive principal component modes, which were associated with vorticity and pulmonary regurgitant volume (PRV) using univariate and multivariate linear regression. Univariate analysis showed that indexed PRV correlated with 3 modes (r = −0.55,−0.50, and 0.6, all p < 0.05) associated with RV dilatation and an increase in basal bulging, apical bulging and tricuspid annulus tilting with more severe regurgitation, as well as a smaller LV and paradoxical movement of the septum. RV outflow and inflow vorticity were also correlated with these modes. However, total vorticity over the whole RV was correlated with two different modes (r = −0.62,−0.69, both p < 0.05). Higher vorticity was associated with both RV and LV shape changes including longer ventricular length, a larger bulge beside the tricuspid valve, and distinct tricuspid tilting. RV flow vorticity was associated with changes in biventricular geometry, distinct from associations with PRV. Flow vorticity may provide additional mechanistic information in rToF remodeling. Both LV and RV shapes are important in rToF RV flow patterns.
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Affiliation(s)
- Ayah Elsayed
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Charlène A. Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Edward Ferdian
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Miriam Scadeng
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - Boris S. Lowe
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Andrew D. McCulloch
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Jeffrey H. Omens
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Sachin Govil
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Kuberan Pushparajah
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King's College London, London, United Kingdom
- *Correspondence: Alistair A. Young
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171
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Tasca G, Sturla F, Jaworek M, Giese D, Menicanti L, Vismara R, Lombardi M, Redaelli A. In vitro four-dimensional flow magnetic resonance analysis of the effect of pericardial valve design on aortic flow. J Med Eng Technol 2022; 46:209-219. [DOI: 10.1080/03091902.2022.2026505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Giordano Tasca
- Cardiac Surgery Department, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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172
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Grafton-Clarke C, Thornton G, Fidock B, Archer G, Hose R, van der Geest RJ, Zhong L, Swift AJ, Wild JM, De Gárate E, Bucciarelli-Ducci C, Plein S, Treibel TA, Flather M, Vassiliou VS, Garg P. Mitral regurgitation quantification by cardiac magnetic resonance imaging (MRI) remains reproducible between software solutions. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17200.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The reproducibility of mitral regurgitation (MR) quantification by cardiovascular magnetic resonance (CMR) imaging using different software solutions remains unclear. This research aimed to investigate the reproducibility of MR quantification between two software solutions: MASS (version 2019 EXP, LUMC, Netherlands) and CAAS (version 5.2, Pie Medical Imaging). Methods: CMR data of 35 patients with MR (12 primary MR, 13 mitral valve repair/replacement, and ten secondary MR) was used. Four methods of MR volume quantification were studied, including two 4D-flow CMR methods (MRMVAV and MRJet) and two non-4D-flow techniques (MRStandard and MRLVRV). We conducted within-software and inter-software correlation and agreement analyses. Results: All methods demonstrated significant correlation between the two software solutions: MRStandard (r=0.92, p<0.001), MRLVRV (r=0.95, p<0.001), MRJet (r=0.86, p<0.001), and MRMVAV (r=0.91, p<0.001). Between CAAS and MASS, MRJet and MRMVAV, compared to each of the four methods, were the only methods not to be associated with significant bias. Conclusions: We conclude that 4D-flow CMR methods demonstrate equivalent reproducibility to non-4D-flow methods but greater levels of agreement between software solutions.
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173
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Zhao X, Hu L, Leng S, Tan RS, Chai P, Bryant JA, Teo LLS, Fortier MV, Yeo TJ, Ouyang RZ, Allen JC, Hughes M, Garg P, Zhang S, van der Geest RJ, Yip JW, Tan TH, Tan JL, Zhong Y, Zhong L. Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:4. [PMID: 34980199 PMCID: PMC8722058 DOI: 10.1186/s12968-021-00832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows quantification of biventricular blood flow by flow components and kinetic energy (KE) analyses. However, it remains unclear whether 4D flow parameters can predict cardiopulmonary exercise testing (CPET) as a clinical outcome in repaired tetralogy of Fallot (rTOF). Current study aimed to (1) compare 4D flow CMR parameters in rTOF with age- and gender-matched healthy controls, (2) investigate associations of 4D flow parameters with functional and volumetric right ventricular (RV) remodelling markers, and CPET outcome. METHODS Sixty-three rTOF patients (14 paediatric, 49 adult; 30 ± 15 years; 29 M) and 63 age- and gender-matched healthy controls (14 paediatric, 49 adult; 31 ± 15 years) were prospectively recruited at four centers. All underwent cine and 4D flow CMR, and all adults performed standardized CPET same day or within one week of CMR. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes. Four flow components were analyzed: direct flow, retained inflow, delayed ejection flow and residual volume. Additionally, three phasic KE parameters normalized to end-diastolic volume (KEiEDV), were analyzed for both LV and RV: peak systolic, average systolic and peak E-wave. RESULTS In comparisons of rTOF vs. healthy controls, median LV retained inflow (18% vs. 16%, P = 0.005) and median peak E-wave KEiEDV (34.9 µJ/ml vs. 29.2 µJ/ml, P = 0.006) were higher in rTOF; median RV direct flow was lower in rTOF (25% vs. 35%, P < 0.001); median RV delayed ejection flow (21% vs. 17%, P < 0.001) and residual volume (39% vs. 31%, P < 0.001) were both greater in rTOF. RV KEiEDV parameters were all higher in rTOF than healthy controls (all P < 0.001). On multivariate analysis, RV direct flow was an independent predictor of RV function and CPET outcome. RV direct flow and RV peak E-wave KEiEDV were independent predictors of RV remodelling index. CONCLUSIONS In this multi-scanner multicenter 4D flow CMR study, reduced RV direct flow was independently associated with RV dysfunction, remodelling and, to a lesser extent, exercise intolerance in rTOF patients. This supports its utility as an imaging parameter for monitoring disease progression and therapeutic response in rTOF. Clinical Trial Registration https://www.clinicaltrials.gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
| | - Rong Zhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
| | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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174
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Mura J, Sotelo J, Mella H, Wong J, Hussain T, Ruijsink B, Uribe S. Non-invasive local pulse wave velocity using 4D-flow MRI. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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175
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Desai L, Stefek H, Berhane H, Robinson J, Rigsby C, Markl M. Four-Dimensional flow Magnetic Resonance Imaging for Assessment of Pediatric Coarctation of the Aorta. J Magn Reson Imaging 2022; 55:200-208. [PMID: 34173693 PMCID: PMC9084555 DOI: 10.1002/jmri.27802] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) typically requires repair, but re-interventions and vascular complications occur, particularly with associated defects like bicuspid aortic valve (BAV). Magnetic resonance imaging (MRI) may identify anatomic and hemodynamic factors contributing to clinical complications. PURPOSE To investigate 4D flow MRI characteristics in pediatric CoA to determine parameters for long-term clinical surveillance. STUDY TYPE Retrospective. POPULATION CoA (n = 21), CoA with BAV (n = 24), BAV alone (n = 29), and healthy control (n = 25). FIELD STRENGTH/SEQUENCE A 1.5 T, 3D CE IR FLASH MRA, 4D flow MRI using 3D time resolved PC-MRI with velocity encoding. ASSESSMENT Thoracic aorta diameters were measured from 3D CE-MRA. Peak systolic velocities and wall shear stress were calculated and flow patterns were visualized throughout the thoracic aorta using 4D flow. Repair characteristics, re-interventions, and need for anti-hypertensive medications were recorded. STATISTICS Descriptive statistics, ANOVA with post hoc t-testing and Bonferroni correction, Kruskal-Wallis H, intraclass correlation coefficient, Fleiss' kappa. RESULTS Patients with CoA with or without repair had smaller transverse arch diameters compared to BAV alone and control cohorts (P < 0.05), higher peak systolic flow velocities and wall shear stress compared to controls in the transverse arch and descending aorta (P < 0.05), and flow derangements in the descending aorta. The most common CoA repairs were extended end-to-end anastomosis (n = 22/45, 48.9%, age at repair 1 ± 2 years, seven re-interventions) and stent/interposition graft placement (n = 10/45, 22.2%, age at repair 12 ± 3 years, one re-intervention). Anti-hypertensive medications were prescribed to 33.3% (n = 15/45) of CoA and 34.4% of BAV alone patients (n = 10/29). DATA CONCLUSIONS Despite repair, CoA alters hemodynamics and flow patterns in the transverse arch and descending aorta. These findings may contribute to vascular remodeling and secondary complications. 4D flow MRI may be valuable in risk stratification, treatment selection and postintervention assessment. Long-term, prospective studies are warranted to correlate patient and MRI factors with clinical outcomes. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lajja Desai
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | | | - Haben Berhane
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Joshua Robinson
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Cynthia Rigsby
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
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176
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Corrado PA, Seiter DP, Wieben O. Automatic measurement plane placement for 4D Flow MRI of the great vessels using deep learning. Int J Comput Assist Radiol Surg 2022; 17:199-210. [PMID: 34403045 PMCID: PMC8851604 DOI: 10.1007/s11548-021-02475-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/03/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Despite the great potential and flexibility of 4D flow MRI for hemodynamic analysis, a major limitation is the need for time-consuming and user-dependent post-processing. We propose a fast four-step algorithm for rapid, robust, and repeatable flow measurements in the great vessels based on automatic placement of measurement planes and vessel segmentation. METHODS Our algorithm works by (1) subsampling the 3D image into 3D patches, (2) predicting the probability of each patch containing individual vessels and location/orientation of the vessel within the patch via a convolutional neural network, (3) selecting the predicted planes with highest probabilities for each vessel, and (4) shifting the plane centers to the maximum velocity within each plane. The method was trained on 283 scans and evaluated on 40 unseen scans by comparing algorithm-derived processing times, plane locations, and flow measurements to those of two manual observers (graduate students) using t-tests, Pearson correlation, and Bland-Altman analysis. RESULTS The average processing time for the algorithm (18 s) was shorter than observer 1 (362 s; P < 0.001) and observer 2 (317 s; P < 0.001). The distance between planes placed by the algorithm and those placed by manual observers was slightly greater (O1 vs. algorithm: 9.0 mm, O2 vs. algorithm: 10.3 mm) than the distance between planes placed by the two manual observers (8.3 mm). The correlation between flow values for planes placed by the algorithm and those placed by manual observers was slightly lower (O1 vs. algorithm: R = 0.68, O2 vs. algorithm: R = 0.72) than the flow correlation between the two manual observers (R = 0.81). CONCLUSION Our method is a feasible and accurate approach for fast, reproducible, and automated flow measurement and visualization in 4D flow MRI of the great vessels, with similar variability compared to a manual annotator as the variability between two manual observers. This approach could be applied in other anatomical regions.
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Affiliation(s)
- Philip A. Corrado
- Department of Medical Physics, University of Wisconsin-Madison,
Madison, Wisconsin, USA
| | - Daniel P. Seiter
- Department of Medical Physics, University of Wisconsin-Madison,
Madison, Wisconsin, USA
| | - Oliver Wieben
- Departments of Medical Physics and Radiology, University of
Wisconsin-Madison, Madison, Wisconsin, USA
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Nahardani A, Leistikow S, Grün K, Krämer M, Herrmann KH, Schrepper A, Jung C, Moradi S, Schulze PC, Linsen L, Reichenbach JR, Hoerr V, Franz M. Pulmonary Arteriovenous Pressure Gradient and Time-Averaged Mean Velocity of Small Pulmonary Arteries Can Serve as Sensitive Biomarkers in the Diagnosis of Pulmonary Arterial Hypertension: A Preclinical Study by 4D-Flow MRI. Diagnostics (Basel) 2021; 12:diagnostics12010058. [PMID: 35054225 PMCID: PMC8774481 DOI: 10.3390/diagnostics12010058] [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: 11/15/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
(1) Background: Pulmonary arterial hypertension (PAH) is a serious condition that is associated with many cardiopulmonary diseases. Invasive right heart catheterization (RHC) is currently the only method for the definitive diagnosis and follow-up of PAH. In this study, we sought a non-invasive hemodynamic biomarker for the diagnosis of PAH. (2) Methods: We applied prospectively respiratory and cardiac gated 4D-flow MRI at a 9.4T preclinical scanner on three different groups of Sprague Dawley rats: baseline (n = 11), moderate PAH (n = 8), and severe PAH (n = 8). The pressure gradients as well as the velocity values were analyzed from 4D-flow data and correlated with lung histology. (3) Results: The pressure gradient between the pulmonary artery and vein on the unilateral side as well as the time-averaged mean velocity values of the small pulmonary arteries were capable of distinguishing not only between baseline and severe PAH, but also between the moderate and severe stages of the disease. (4) Conclusions: The current preclinical study suggests the pulmonary arteriovenous pressure gradient and the time-averaged mean velocity as potential biomarkers to diagnose PAH.
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Affiliation(s)
- Ali Nahardani
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53127 Bonn, Germany;
| | - Simon Leistikow
- Department of Mathematics and Computer Science, Institute of Computer Science, Westfälische Wilhelms-Universität Münster, 48149 Munster, Germany; (S.L.); (L.L.)
| | - Katja Grün
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Jena University Hospital, 07747 Jena, Germany; (K.G.); (P.C.S.); (M.F.)
| | - Martin Krämer
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
| | - Karl-Heinz Herrmann
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, Jena University Hospital, 07747 Jena, Germany;
| | - Christian Jung
- Department of Internal Medicine, Division of Cardiology, University Hospital Düsseldorf, 40225 Dusseldorf, Germany;
| | - Sara Moradi
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53127 Bonn, Germany;
| | - Paul Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Jena University Hospital, 07747 Jena, Germany; (K.G.); (P.C.S.); (M.F.)
| | - Lars Linsen
- Department of Mathematics and Computer Science, Institute of Computer Science, Westfälische Wilhelms-Universität Münster, 48149 Munster, Germany; (S.L.); (L.L.)
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
| | - Verena Hoerr
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany; (A.N.); (M.K.); (K.-H.H.); (J.R.R.)
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53127 Bonn, Germany;
- Translational Research Imaging Center (TRIC), Clinic for Radiology, University Hospital Münster, 48149 Munster, Germany
- Correspondence:
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Jena University Hospital, 07747 Jena, Germany; (K.G.); (P.C.S.); (M.F.)
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178
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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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179
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Evaluation of intraventricular flow by multimodality imaging: a review and meta-analysis. Cardiovasc Ultrasound 2021; 19:38. [PMID: 34876127 PMCID: PMC8653587 DOI: 10.1186/s12947-021-00269-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this systematic review was to evaluate current inter-modality agreement of noninvasive clinical intraventricular flow (IVF) assessment with 3 emerging imaging modalities: echocardiographic particle image velocimetry (EPIV), vector flow mapping (VFM), and 4-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). Methods We performed a systematic literature review in the databases EMBASE, Medline OVID and Cochrane Central for identification of studies evaluating left ventricular (LV) flow patterns using one of these flow visualization modalities. Of the 2224 initially retrieved records, 10 EPIV, 23 VFM, and 25 4D flow CMR studies were included in the final analysis. Results Vortex parameters were more extensively studied with EPIV, while LV energetics and LV transport mechanics were mainly studied with 4D flow CMR, and LV energy loss and vortex circulation were implemented by VFM studies. Pooled normative values are provided for these parameters. The meta- analysis for the values of two vortex morphology parameters, vortex length and vortex depth, failed to reveal a significant change between heart failure patients and healthy controls. Conclusion Agreement between the different modalities studying intraventricular flow is low and different methods of measurement and reporting were used among studies. A multimodality framework with a standardized set of flow parameters is necessary for implementation of noninvasive flow visualization in daily clinical practice. The full potential of noninvasive flow visualization in addition to diagnostics could also include guiding medical or interventional treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00269-8.
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180
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Gabbert DD, Trotz P, Kheradvar A, Jerosch-Herold M, Scheewe J, Kramer HH, Voges I, Rickers C. Abnormal torsion and helical flow patterns of the neo-aorta in hypoplastic left heart syndrome assessed with 4D-flow MRI. Cardiovasc Diagn Ther 2021; 11:1379-1388. [PMID: 35070806 PMCID: PMC8748477 DOI: 10.21037/cdt-20-770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/08/2020] [Indexed: 07/22/2023]
Abstract
BACKGROUND The Norwood procedure is the first stage of correction for patients with hypoplastic left heart syndrome (HLHS) and may lead to an abnormal neoaortic anatomy. We prospectively studied the neoaorta's fluid dynamics and the abnormal twist of the neoaorta by MRI examinations of HLHS patients in Fontan circulation. This study for the first time investigates the hypothesis that the neoaorta twist is associated with increased helical flow patterns, which may lead to an increased workload for the systemic right ventricle (RV) and ultimately to RV hypertrophy. METHODS A group of forty-two HLHS patients with a median age of 4.9 (2.9-17.0) years, at NYHA I was studied along with a control group of eleven subjects with healthy hearts and a median age of 12.1 (4.0-41.6). All subjects underwent MRI of the thoracic aorta including ECG-gated 2D balanced SSFP cine for an axial slice stack and 4D-flow MRI for a sagittal volume slab covering the thoracic aorta. The twist of the neoaortic arch was quantified by the effective geometric torsion, defined as the product of curvature and geometric torsion. Fluid dynamics and geometry in the neoaorta, including the flow helicity index, were evaluated using an in-house analysis software (MeVisLab-based). Myocardial mass of the systemic ventricle at end-diastole was estimated by planimetry of the short-axis stack. RESULTS Compared to the control group, the neoaorta in the HLHS patients shows an increased twist (P=0.04) and higher peak helicity density (P=0.03). The maximum helicity density was correlated with maximum effective torsion of the ascending neoaorta (P<0.001). The degree of maximum twist correlated with the increase in RV myocardial mass (P<0.01). CONCLUSIONS This study shows that the abnormal twist of the neoaortic arch in HLHS patients is associated with abnormal helical flow patterns, which may contribute to increased RV afterload and may adversely affect the systemic RV by stimulation of myocardial hypertrophy. These findings suggest that further improvements of surgical aortic reconstruction, guided by insights from 4D-flow MRI, could lead to better neoaortic fluid dynamics in patients with HLHS.
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Affiliation(s)
- Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Patrick Trotz
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, CA, Irvine, USA
| | | | - Jens Scheewe
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Carsten Rickers
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
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181
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Zhang J, Rothenberger SM, Brindise MC, Scott MB, Berhane H, Baraboo JJ, Markl M, Rayz VL, Vlachos PP. Divergence-Free Constrained Phase Unwrapping and Denoising for 4D Flow MRI Using Weighted Least-Squares. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3389-3399. [PMID: 34086567 PMCID: PMC8714458 DOI: 10.1109/tmi.2021.3086331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A novel divergence-free constrained phase unwrapping method was proposed and evaluated for 4D flow MRI. The unwrapped phase field was obtained by integrating the phase variations estimated from the wrapped phase data using weighted least-squares. The divergence-free constraint for incompressible blood flow was incorporated to regulate and denoise the resulting phase field. The proposed method was tested on synthetic phase data of left ventricular flow and in vitro 4D flow measurement of Poiseuille flow. The method was additionally applied to in vivo 4D flow measurements in the thoracic aorta from 30 human subjects. The performance of the proposed method was compared to the state-of-the-art 4D single-step Laplacian algorithm. The synthetic phase data were completely unwrapped by the proposed method for all the cases with velocity encoding (venc) as low as 20% of the maximum velocity and signal-to-noise ratio as low as 5. The in vitro Poiseuille flow data were completely unwrapped with a 60% increase in the velocity-to-noise ratio. For the in-vivo aortic datasets with venc ratio less than 0.4, the proposed method significantly improved the success rate by as much as 40% and reduced the velocity error levels by a factor of 10 compared to the state-of-the-art method. The divergence-free constrained method exhibits reliability and robustness on phase unwrapping and shows improved accuracy of velocity and hemodynamic quantities by unwrapping the low-venc 4D flow MRI data.
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182
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Roldán-Alzate A, Grist TM. Deep Learning for Optimization of Abdominopelvic 4D Flow MRI Analysis. Radiology 2021; 302:593-594. [PMID: 34846210 DOI: 10.1148/radiol.212702] [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)
- Alejandro Roldán-Alzate
- From the Departments of Radiology (A.R., T.M.G.) and Mechanical Engineering (A.R.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Thomas M Grist
- From the Departments of Radiology (A.R., T.M.G.) and Mechanical Engineering (A.R.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
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183
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Kollmeier JM, Kalentev O, Klosowski J, Voit D, Frahm J. Velocity vector reconstruction for real-time phase-contrast MRI with radial Maxwell correction. Magn Reson Med 2021; 87:1863-1875. [PMID: 34850452 DOI: 10.1002/mrm.29108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To develop an auto-calibrated image reconstruction for highly accelerated multi-directional phase-contrast (PC) MRI that compensates for (1) reconstruction instabilities occurring for phase differences near ± π and (2) phase errors by concomitant magnetic fields that differ for individual radial spokes. THEORY AND METHODS A model-based image reconstruction for real-time PC MRI based on nonlinear inversion is extended to multi-directional flow by exploiting multiple flow-encodings for the estimation of velocity vectors. An initial smoothing constraint during iterative optimization is introduced to resolve the ambiguity of the solution space by penalizing phase wraps. Maxwell terms are considered as part of the signal model on a line-by-line basis to address phase errors by concomitant magnetic fields. The reconstruction methods are evaluated using simulated data and cross-sectional imaging of a rotating-disc, as well as in vivo for the aortic arch and cervical spinal canal at 3T. RESULTS Real-time three-directional velocity mapping in the aortic arch is achieved at 1.8 × 1.8 × 6 mm3 spatial and 60 ms temporal resolution. Artificial phase wraps are avoided in all cases using the smoothness constraint. Inter-spoke differences of concomitant magnetic fields are effectively compensated for by the model-based image reconstruction with integrated radial Maxwell correction. CONCLUSION Velocity vector reconstructions based on nonlinear inversion allow for high degrees of radial data undersampling paving the way for multi-directional PC MRI in real time. Whether a spoke-wise treatment of Maxwell terms is required or a computationally cheaper frame-wise approach depends on the individual application.
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Affiliation(s)
- Jost M Kollmeier
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Oleksandr Kalentev
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Jakob Klosowski
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Dirk Voit
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
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You S, Masutani EM, Alley MT, Vasanawala SS, Taub PR, Liau J, Roberts AC, Hsiao A. Deep Learning Automated Background Phase Error Correction for Abdominopelvic 4D Flow MRI. Radiology 2021; 302:584-592. [PMID: 34846200 PMCID: PMC8893183 DOI: 10.1148/radiol.2021211270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Four-dimensional (4D) flow MRI has the potential to provide hemodynamic insights for a variety of abdominopelvic vascular diseases, but its clinical utility is currently impaired by background phase error, which can be challenging to correct. Purpose To assess the feasibility of using deep learning to automatically perform image-based background phase error correction in 4D flow MRI and to compare its effectiveness relative to manual image-based correction. Materials and Methods A convenience sample of 139 abdominopelvic 4D flow MRI acquisitions performed between January 2016 and July 2020 was retrospectively collected. Manual phase error correction was performed using dedicated imaging software and served as the reference standard. After reserving 40 examinations for testing, the remaining examinations were randomly divided into training (86% [85 of 99]) and validation (14% [14 of 99]) data sets to train a multichannel three-dimensional U-Net convolutional neural network. Flow measurements were obtained for the infrarenal aorta, common iliac arteries, common iliac veins, and inferior vena cava. Statistical analyses included Pearson correlation, Bland-Altman analysis, and F tests with Bonferroni correction. Results A total of 139 patients (mean age, 47 years ± 14 [standard deviation]; 108 women) were included. Inflow-outflow correlation improved after manual correction (ρ = 0.94, P < .001) compared with that before correction (ρ = 0.50, P < .001). Automated correction showed similar results (ρ = 0.91, P < .001) and demonstrated very strong correlation with manual correction (ρ = 0.98, P < .001). Both correction methods reduced inflow-outflow variance, improving mean difference from -0.14 L/min (95% limits of agreement: -1.61, 1.32) (uncorrected) to 0.05 L/min (95% limits of agreement: -0.32, 0.42) (manually corrected) and 0.05 L/min (95% limits of agreement: -0.38, 0.49) (automatically corrected). There was no significant difference in inflow-outflow variance between manual and automated correction methods (P = .10). Conclusion Deep learning automated phase error correction reduced inflow-outflow bias and variance of volumetric flow measurements in four-dimensional flow MRI, achieving results comparable with manual image-based phase error correction. © RSNA, 2021 See also the editorial by Roldán-Alzate and Grist in this issue.
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Affiliation(s)
- Sophie You
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
| | - Evan M. Masutani
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
| | - Marcus T. Alley
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
| | - Shreyas S. Vasanawala
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
| | - Pam R. Taub
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
| | - Joy Liau
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
| | - Anne C. Roberts
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
| | - Albert Hsiao
- From the School of Medicine (S.Y., E.M.M.), Department of Cardiovascular Medicine (P.R.T.), and Department of Radiology (J.L., A.C.R., A.H.), University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A., S.S.V.)
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Weingärtner S, Desmond KL, Obuchowski NA, Baessler B, Zhang Y, Biondetti E, Ma D, Golay X, Boss MA, Gunter JL, Keenan KE, Hernando D. Development, validation, qualification, and dissemination of quantitative MR methods: Overview and recommendations by the ISMRM quantitative MR study group. Magn Reson Med 2021; 87:1184-1206. [PMID: 34825741 DOI: 10.1002/mrm.29084] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/26/2022]
Abstract
On behalf of the International Society for Magnetic Resonance in Medicine (ISMRM) Quantitative MR Study Group, this article provides an overview of considerations for the development, validation, qualification, and dissemination of quantitative MR (qMR) methods. This process is framed in terms of two central technical performance properties, i.e., bias and precision. Although qMR is confounded by undesired effects, methods with low bias and high precision can be iteratively developed and validated. For illustration, two distinct qMR methods are discussed throughout the manuscript: quantification of liver proton-density fat fraction, and cardiac T1 . These examples demonstrate the expansion of qMR methods from research centers toward widespread clinical dissemination. The overall goal of this article is to provide trainees, researchers, and clinicians with essential guidelines for the development and validation of qMR methods, as well as an understanding of necessary steps and potential pitfalls for the dissemination of quantitative MR in research and in the clinic.
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Affiliation(s)
- Sebastian Weingärtner
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Kimberly L Desmond
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bettina Baessler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Yuxin Zhang
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Emma Biondetti
- Department of Neuroscience, Imaging and Clinical Sciences, D'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Dan Ma
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xavier Golay
- Brain Repair & Rehabilitation, Institute of Neurology, University College London, United Kingdom.,Gold Standard Phantoms Limited, Rochester, United Kingdom
| | - Michael A Boss
- Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania, USA
| | | | - Kathryn E Keenan
- National Institute of Standards and Technology, Boulder, Colorado, USA
| | - Diego Hernando
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Trenti C, Dyverfeldt P. Editorial for "Segmentation of the Aorta and Pulmonary Arteries Based on 4D Flow MRI in the Pediatric Setting Using Fully Automated Multi-Site, Multi-Vendor, and Multi-Label Dense U-Net". J Magn Reson Imaging 2021; 55:1681-1682. [PMID: 34816520 DOI: 10.1002/jmri.28005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chiara Trenti
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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187
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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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188
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Dillinger H, McGrath C, Guenthner C, Kozerke S. Fundamentals of turbulent flow spectrum imaging. Magn Reson Med 2021; 87:1231-1249. [PMID: 34786764 PMCID: PMC9299145 DOI: 10.1002/mrm.29001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To introduce a mathematical framework and in-silico validation of turbulent flow spectrum imaging (TFSI) of stenotic flow using phase-contrast MRI, evaluate systematic errors in quantitative turbulence parameter estimation, and propose a novel method for probing the Lagrangian velocity spectra of turbulent flows. THEORY AND METHODS The spectral response of velocity-encoding gradients is derived theoretically and linked to turbulence parameter estimation including the velocity autocorrelation function spectrum. Using a phase-contrast MRI simulation framework, the encoding properties of bipolar gradient waveforms with identical first gradient moments but different duration are investigated on turbulent flow data of defined characteristics as derived from computational fluid dynamics. Based on theoretical insights, an approach using velocity-compensated gradient waveforms is proposed to specifically probe desired ranges of the velocity autocorrelation function spectrum with increased accuracy. RESULTS Practical velocity-encoding gradients exhibit limited encoding power of typical turbulent flow spectra, resulting in up to 50% systematic underestimation of intravoxel SD values. Depending on the turbulence level in fluids, the error due to a single encoding gradient spectral response can vary by 20%. When using tailored velocity-compensated gradients, improved quantification of the Lagrangian velocity spectrum on a voxel-by-voxel basis is achieved and used for quantitative correction of intravoxel SD values estimated with velocity-encoding gradients. CONCLUSION To address systematic underestimation of turbulence parameters using bipolar velocity-encoding gradients in phase-contrast MRI of stenotic flows with short correlation times, tailored velocity-compensated gradients are proposed to improve quantitative mapping of turbulent blood flow characteristics.
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Affiliation(s)
- Hannes Dillinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Charles McGrath
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Christian Guenthner
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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189
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Schäfer M, Frank BS, Grady RM, Eghtesady P, Mitchell MB, Jaggers J, Ivy DD. Monitoring and evaluation of the surgical Potts shunt physiology using 4-dimensional flow magnetic resonance imaging. J Thorac Cardiovasc Surg 2021; 164:331-341. [PMID: 34872760 DOI: 10.1016/j.jtcvs.2021.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The reversed Potts shunt is an increasingly applied mode of surgical palliation of severe pulmonary hypertension (PH). However, the long-term flow hemodynamic effect of the Potts shunt physiology and desirable long-term hemodynamic end points are not defined. The purpose of this descriptive study was to analyze a series of pediatric patients who underwent surgical Potts shunt as a part of end-stage PH palliation using 4-dimensional (4D)-flow magnetic resonance imaging (MRI) to (1) quantitate the flow through the anastomosis, (2) correlate the shunting pattern with phases of cardiac cycle and PH comorbidities, and (3) describe chronologic changes in shunting pattern. METHODS This was a 2-center study evaluating 4 patients seen in the Pulmonary Hypertension Clinic at Children's Hospital Colorado who were evaluated and selected to undergo surgical reverse Potts shunt at Washington University School of Medicine and were serially followed using comprehensive imaging including cardiac MRI and 4D-flow MRI. RESULTS After the procedure, each child underwent 2 4D-flow MRI evaluations. Pulmonary pressure offload was evident in all patients, as demonstrated by positive systolic right-to-left flow across the Potts shunt. All patients experienced some degree of the flow reversal, which occurs primarily in diastole. Interventricular dyssynchrony further contributed to flow reversal across the Potts shunt. Lastly, systemic and pulmonary blood mixing in the descending aorta results in secondary helical flow persisting throughout the diastole. CONCLUSIONS 4D-flow MRI demonstrates that children who have undergone a Potts shunt for severe PH can experience shunt flow reversal. Cumulatively, this left-to-right pulmonary shunt adds to right ventricular volume overload. We speculate that a valved conduit may decrease the left to right shunting and improve overall cardiac output.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver
- Anschutz Medical Campus, Aurora, Colo.
| | - Benjamin S Frank
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver
- Anschutz Medical Campus, Aurora, Colo
| | - R Mark Grady
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Max B Mitchell
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver
- Anschutz Medical Campus, Aurora, Colo
| | - James Jaggers
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver
- Anschutz Medical Campus, Aurora, Colo
| | - D Dunbar Ivy
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver
- Anschutz Medical Campus, Aurora, Colo
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Hälvä R, Vaara SM, Peltonen JI, Kaasalainen TT, Holmström M, Lommi J, Suihko S, Rajala H, Kylmälä M, Kivistö S, Syväranta S. Peak flow measurements in patients with severe aortic stenosis: a prospective comparative study between cardiovascular magnetic resonance 2D and 4D flow and transthoracic echocardiography. J Cardiovasc Magn Reson 2021; 23:132. [PMID: 34775954 PMCID: PMC8591846 DOI: 10.1186/s12968-021-00825-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aortic valve stenosis (AS) is the most prevalent valvular disease in the developed countries. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) is an emerging imaging technique, which has been suggested to improve the evaluation of AS severity compared to two-dimensional (2D) flow and transthoracic echocardiography (TTE). We investigated the reliability of CMR 2D flow and 4D flow techniques in measuring aortic transvalvular peak systolic flow in patients with severe AS. METHODS We prospectively recruited 90 patients referred for aortic valve replacement due to severe AS (73.3 ± 11.3 years, aortic valve area 0.7 ± 0.1 cm2, and 54/36 tricuspid/bicuspid), and 10 non-valvular disease controls. All the patients underwent echocardiography and 2D flow and 4D flow CMR. Peak flow velocity measurements were compared using Wilcoxon signed rank sum test and Bland-Altman analysis. RESULTS 4D flow underestimated peak flow velocity in the AS group when compared with TTE (bias - 1.1 m/s, limits of agreement ± 1.4 m/s) and 2D flow (bias - 1.2 m/s, limits of agreement ± 1.6 m/s). The differences between values obtained by TTE (median 4.3 m/s, range 2.7-6.1 m/s) and 2D flow (median 4.5 m/s, range 2.9-6.5 m/s) compared to 4D flow (median 3.1 m/s, range 1.7-5.1 m/s) were significant (p < 0.001). The difference between 2D flow and TTE were insignificant (bias 0.07 m/s, limits of agreement ± 1.5 m/s). In non-valvular disease controls, peak flow velocity was measured higher by 4D flow than 2D flow (1.4 m/s, 1.1-1.7 m/s and 1.3 m/s, 1.1-1.5 m/s, respectively; bias 0.2 m/s, limits of agreement ± 0.16 m/s). CONCLUSIONS CMR 4D flow significantly underestimates systolic peak flow velocity in patients with severe AS. 2D flow, in turn, estimated the AS velocity accurately, with measured peak flow velocities comparable to TTE.
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Affiliation(s)
- Reetta Hälvä
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu M. Vaara
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha I. Peltonen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Touko T. Kaasalainen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jyri Lommi
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Suihko
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Rajala
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Kylmälä
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Kivistö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi Syväranta
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Holtackers RJ, Wildberger JE, Wintersperger BJ, Chiribiri A. Impact of Field Strength in Clinical Cardiac Magnetic Resonance Imaging. Invest Radiol 2021; 56:764-772. [PMID: 34261084 DOI: 10.1097/rli.0000000000000809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACT Cardiac magnetic resonance imaging (MRI) is widely applied for the noninvasive assessment of cardiac structure and function, and for tissue characterization. For more than 2 decades, 1.5 T has been considered the field strength of choice for cardiac MRI. Although the number of 3-T systems significantly increased in the past 10 years and numerous new developments were made, challenges seem to remain that hamper a widespread clinical use of 3-T MR systems for cardiac applications. As the number of clinical cardiac applications is increasing, with each having their own benefits at both field strengths, no "holy grail" field strength exists for cardiac MRI that one should ideally use. This review describes the physical differences between 1.5 and 3 T, as well as the effect of these differences on major (routine) cardiac MRI applications, including functional imaging, edema imaging, late gadolinium enhancement, first-pass stress perfusion, myocardial mapping, and phase contrast flow imaging. For each application, the advantages and limitations at both 1.5 and 3 T are discussed. Solutions and alternatives are provided to overcome potential limitations. Finally, we briefly elaborate on the potential use of alternative field strengths (ie, below 1.5 T and above 3 T) for cardiac MRI and conclude with field strength recommendations for the future of cardiac MRI.
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Abstract
Coronary artery fistulas are uncommon but clinically important entities that may produce symptoms and significant complications such as angina, myocardial infarction, coronary artery aneurysm formation, and congestive heart failure. Multiple fistula types have been recognized, and classification uses factors such as etiology, coronary artery origin, and drainage site. Both invasive and noninvasive imaging play an important role in the management and treatment of these patients, and often times, more than one modality is necessary for comprehensive evaluation of coronary fistulas. Recent advances in both functional and anatomic imaging will likely also play a growing role in fistula evaluation. The purpose of this article is to review the classification, pathophysiology, clinical presentations, imaging findings, treatment, and future imaging directions of coronary artery fistulas.
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193
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Yao X, Hu L, Peng Y, Feng F, Ouyang R, Xie W, Wang Q, Sun A, Zhong Y. Right and left ventricular function and flow quantification in pediatric patients with repaired tetralogy of Fallot using four-dimensional flow magnetic resonance imaging. BMC Med Imaging 2021; 21:161. [PMID: 34719378 PMCID: PMC8559379 DOI: 10.1186/s12880-021-00693-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background To assess the accuracy and reproducibility of right ventricular (RV) and left ventricular (LV) function and flow measurements in children with repaired tetralogy of Fallot (rTOF) using four-dimensional (4D) flow, compared with conventional two-dimensional (2D) magnetic resonance imaging (MRI) sequences. Methods Thirty pediatric patients with rTOF were retrospectively enrolled to undergo 2D balanced steady-state free precession cine (2D b-SSFP cine), 2D phase contrast (PC), and 4D flow cardiac MRI. LV and RV volumes and flow in the ascending aorta (AAO) and main pulmonary artery (MPA) were quantified. Pearson’s or Spearman’s correlation tests, paired t-tests, the Wilcoxon signed-rank test, Bland–Altman analysis, and intraclass correlation coefficients (ICC) were performed. Results The 4D flow scan time was shorter compared with 2D sequences (P < 0.001). The biventricular volumes between 4D flow and 2D b-SSFP cine had no significant differences (P > 0.05), and showed strong correlations (r > 0.90, P < 0.001) and good consistency. The flow measurements of the AAO and MPA between 4D flow and 2D PC showed moderate to good correlations (r > 0.60, P < 0.001). There was good internal consistency in cardiac output. There was good intraobserver and interobserver biventricular function agreement (ICC > 0.85). Conclusions RV and LV function and flow quantification in pediatric patients with rTOF using 4D flow MRI can be measured accurately and reproducibly compared to those with conventional 2D sequences.
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Affiliation(s)
- Xiaofen Yao
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Yafeng Peng
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Fei Feng
- AI Imaging, GE Healthcare, No. 1 Huatuo Road, Shanghai, 201203, China
| | - Rongzhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Weihui Xie
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Qian Wang
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Aimin Sun
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, 200127, China.
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194
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Ngo MT, Lee UY, Ha H, Jung J, Lee DH, Kwak HS. Improving Blood Flow Visualization of Recirculation Regions at Carotid Bulb in 4D Flow MRI Using Semi-Automatic Segmentation with ITK-SNAP. Diagnostics (Basel) 2021; 11:diagnostics11101890. [PMID: 34679588 PMCID: PMC8534781 DOI: 10.3390/diagnostics11101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open
Abstract
Assessment of carotid bulb hemodynamics using four-dimensional (4D) flow magnetic resonance imaging (MRI) requires accurate segmentation of recirculation regions that is frequently hampered by limited resolution. This study aims to improve the accuracy of 4D flow MRI carotid bulb segmentation and subsequent recirculation regions analysis. Time-of-flight (TOF) MRI and 4D flow MRI were performed on bilateral carotid artery bifurcations in seven healthy volunteers. TOF-MRI data was segmented into 3D geometry for computational fluid dynamics (CFD) simulations. ITK-SNAP segmentation software was included in the workflow for the semi-automatic generation of 4D flow MRI angiographic data. This study compared the velocities calculated at the carotid bifurcations and the 3D blood flow visualization at the carotid bulbs obtained by 4D flow MRI and CFD. By applying ITK-SNAP segmentation software, an obvious improvement in the 4D flow MRI visualization of the recirculation regions was observed. The 4D flow MRI images of the recirculation flow characteristics of the carotid artery bulbs coincided with the CFD. A reasonable agreement was found in terms of velocity calculated at the carotid bifurcation between CFD and 4D flow MRI. However, the dispersion of velocity data points relative to the local errors of measurement in 4D flow MRI remains. Our proposed strategy showed the feasibility of improving recirculation regions segmentation and the potential for reliable blood flow visualization in 4D flow MRI. However, quantitative analysis of recirculation regions in 4D flow MRI with ITK-SNAP should be enhanced for use in clinical situations.
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Affiliation(s)
- Minh Tri Ngo
- Department of Radiology of Hue Central Hospital, Hue, Thua Thien Hue 530000, Vietnam;
| | - Ui Yun Lee
- Division of Mechanical Design Engineering, College of Engineering, Jeonbuk National University, Jeon-ju 54896, Korea; (U.Y.L.); (J.J.)
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24341, Korea;
| | - Jinmu Jung
- Division of Mechanical Design Engineering, College of Engineering, Jeonbuk National University, Jeon-ju 54896, Korea; (U.Y.L.); (J.J.)
- Hemorheology Research Institute, Jeonbuk National University, Jeon-ju 54896, Korea
| | - Dong Hwan Lee
- Division of Mechanical Design Engineering, College of Engineering, Jeonbuk National University, Jeon-ju 54896, Korea; (U.Y.L.); (J.J.)
- Hemorheology Research Institute, Jeonbuk National University, Jeon-ju 54896, Korea
- Correspondence: (D.H.L.); (H.S.K.); Tel.: +82-63-270-3998 (D.H.L.); +82-63-250-2582 (H.S.K.)
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeon-ju 54907, Korea
- Correspondence: (D.H.L.); (H.S.K.); Tel.: +82-63-270-3998 (D.H.L.); +82-63-250-2582 (H.S.K.)
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195
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Falcão MBL, Di Sopra L, Ma L, Bacher M, Yerly J, Speier P, Rutz T, Prša M, Markl M, Stuber M, Roy CW. Pilot tone navigation for respiratory and cardiac motion-resolved free-running 5D flow MRI. Magn Reson Med 2021; 87:718-732. [PMID: 34611923 PMCID: PMC8627452 DOI: 10.1002/mrm.29023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/17/2021] [Accepted: 09/03/2021] [Indexed: 11/07/2022]
Abstract
Purpose In this work, we integrated the pilot tone (PT) navigation system into a reconstruction framework for respiratory and cardiac motion‐resolved 5D flow. We tested the hypotheses that PT would provide equivalent respiratory curves, cardiac triggers, and corresponding flow measurements to a previously established self‐gating (SG) technique while being independent from changes to the acquisition parameters. Methods Fifteen volunteers and 9 patients were scanned with a free‐running 5D flow sequence, with PT integrated. Respiratory curves and cardiac triggers from PT and SG were compared across all subjects. Flow measurements from 5D flow reconstructions using both PT and SG were compared to each other and to a reference electrocardiogram‐gated and respiratory triggered 4D flow acquisition. Radial trajectories with variable readouts per interleave were also tested in 1 subject to compare cardiac trigger quality between PT and SG. Results The correlation between PT and SG respiratory curves were 0.95 ± 0.06 for volunteers and 0.95 ± 0.04 for patients. Heartbeat duration measurements in volunteers and patients showed a bias to electrocardiogram measurements of, respectively, 0.16 ± 64.94 ms and 0.01 ± 39.29 ms for PT versus electrocardiogram and of 0.24 ± 63.68 ms and 0.09 ± 32.79 ms for SG versus electrocardiogram. No significant differences were reported for the flow measurements between 5D flow PT and from 5D flow SG. A decrease in the cardiac triggering quality of SG was observed for increasing readouts per interleave, whereas PT quality remained constant. Conclusion PT has been successfully integrated in 5D flow MRI and has shown equivalent results to the previously described 5D flow SG technique, while being completely acquisition‐independent.
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Affiliation(s)
- Mariana B L Falcão
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lorenzo Di Sopra
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Liliana Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Mario Bacher
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Siemens Healthcare GmbH, Erlangen, Germany.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | | | - Tobias Rutz
- Service of Cardiology, Centre de Resonance Magnétique Cardiaque (CRMC), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Milan Prša
- Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Christopher W Roy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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196
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Grafton-Clarke C, Thornton G, Fidock B, Archer G, Hose R, van der Geest RJ, Zhong L, Swift AJ, Wild JM, De Gárate E, Bucciarelli-Ducci C, Plein S, Treibel TA, Flather M, Vassiliou VS, Garg P. Mitral regurgitation quantification by cardiac magnetic resonance imaging (MRI) remains reproducible between software solutions. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17200.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The reproducibility of mitral regurgitation (MR) quantification by cardiovascular magnetic resonance (CMR) imaging using different software solutions remains unclear. This research aimed to investigate the reproducibility of MR quantification between two software solutions: MASS (version 2019 EXP, LUMC, Netherlands) and CAAS (version 5.2, Pie Medical Imaging). Methods: CMR data of 35 patients with MR (12 primary MR, 13 mitral valve repair/replacement, and ten secondary MR) was used. Four methods of MR volume quantification were studied, including two 4D-flow CMR methods (MRMVAV and MRJet) and two non-4D-flow techniques (MRStandard and MRLVRV). We conducted within-software and inter-software correlation and agreement analyses. Results: All methods demonstrated significant correlation between the two software solutions: MRStandard (r=0.92, p<0.001), MRLVRV (r=0.95, p<0.001), MRJet (r=0.86, p<0.001), and MRMVAV (r=0.91, p<0.001). Between CAAS and MASS, MRJet and MRMVAV, compared to each of the four methods, were the only methods not to be associated with significant bias. Conclusions: We conclude that 4D-flow CMR methods demonstrate equivalent reproducibility to non-4D-flow methods but greater levels of agreement between software solutions.
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197
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Fevola E, Ballarin F, Jiménez‐Juan L, Fremes S, Grivet‐Talocia S, Rozza G, Triverio P. An optimal control approach to determine resistance-type boundary conditions from in-vivo data for cardiovascular simulations. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3516. [PMID: 34337877 PMCID: PMC9285750 DOI: 10.1002/cnm.3516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/26/2021] [Indexed: 06/01/2023]
Abstract
The choice of appropriate boundary conditions is a fundamental step in computational fluid dynamics (CFD) simulations of the cardiovascular system. Boundary conditions, in fact, highly affect the computed pressure and flow rates, and consequently haemodynamic indicators such as wall shear stress (WSS), which are of clinical interest. Devising automated procedures for the selection of boundary conditions is vital to achieve repeatable simulations. However, the most common techniques do not automatically assimilate patient-specific data, relying instead on expensive and time-consuming manual tuning procedures. In this work, we propose a technique for the automated estimation of outlet boundary conditions based on optimal control. The values of resistive boundary conditions are set as control variables and optimized to match available patient-specific data. Experimental results on four aortic arches demonstrate that the proposed framework can assimilate 4D-Flow MRI data more accurately than two other common techniques based on Murray's law and Ohm's law.
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Affiliation(s)
- Elisa Fevola
- Department of Electronics and TelecommunicationsPolitecnico di TorinoTorinoItaly
| | - Francesco Ballarin
- MathLab, Mathematics areaSISSA ‐ International School for Advanced StudiesTriesteItaly
- Department of Mathematics and PhysicsCatholic University of the Sacred HeartBresciaItaly
| | - Laura Jiménez‐Juan
- Department of Medical ImagingSt Michael's Hospital and Sunnybrook Research Institute, University of TorontoTorontoCanada
| | - Stephen Fremes
- Schulich Heart CentreSunnybrook Health Sciences Center and Sunnybrook Research Institute, University of TorontoTorontoCanada
| | | | - Gianluigi Rozza
- MathLab, Mathematics areaSISSA ‐ International School for Advanced StudiesTriesteItaly
| | - Piero Triverio
- Department of Electrical & Computer EngineeringInstitute of Biomedical Engineering, University of TorontoTorontoCanada
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198
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Zhao PF, Zeng R, Qiu XY, Ding HY, Lv H, Li XS, Wang GP, Li D, Gong SS, Wang ZC. Diploic vein as a newly treatable cause of pulsatile tinnitus: A case report. World J Clin Cases 2021; 9:8097-8103. [PMID: 34621867 PMCID: PMC8462196 DOI: 10.12998/wjcc.v9.i27.8097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulsatile tinnitus (PT) is an annoying sound that can be eliminated with targeted treatment of the cause. However, the causes of PT have not been fully elucidated.
CASE SUMMARY A 38-year-old woman with right-sided objective PT underwent preoperative computed tomography arteriography and venography (CTA/V). A 3.8 mm vine diploic vein (DV), which passed through the mastoid air cells posteriorly in a dehiscent canal and was continuous with the transverse-sigmoid sinus, was thought to be the causative finding. Four-dimensional flow magnetic resonance (4D flow MR) imaging showed that the blood in the DV flowed toward the transverse-sigmoid sinus. The closer the blood was to the transverse-sigmoid sinus, the higher the velocity. No vortex or turbulence was found in the DV or adjacent transverse sinus. The sound was eliminated immediately after ligation of the DV with no recurrence during a three-month follow-up. No flow signal of the DV was noted on postoperative 4D flow MR.
CONCLUSION A DV may be a treatable cause of PT. CTA/V and 4D flow MR could be utilized to determine the morphological and hemodynamic characteristics of the DV.
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Affiliation(s)
- Peng-Fei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Rong Zeng
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiao-Yu Qiu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - He-Yu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiao-Shuai Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guo-Peng Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Dong Li
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Hebei North University, Langfang 076350, Hebei Province, China
| | - Shu-Sheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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199
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Yang K, Wu S, Samuel OW, Zhang H, Ghista DN, Yang D, Wong KKL. A Hybrid Approach for Cardiac Blood Flow Vortex Ring Identification Based on Optical Flow and Lagrangian Averaged Vorticity Deviation. Front Physiol 2021; 12:698405. [PMID: 34539430 PMCID: PMC8440940 DOI: 10.3389/fphys.2021.698405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The measurement of cardiac blood flow vortex characteristics can help to facilitate the analysis of blood flow dynamics that regulates heart function. However, the complexity of cardiac flow along with other physical limitations makes it difficult to adequately identify the dominant vortices in a heart chamber, which play a significant role in regulating the heart function. Although the existing vortex quantification methods can achieve this goal, there are still some shortcomings: such as low precision, and ignoring the center of the vortex without the description of vortex deformation processes. To address these problems, an optical flow Lagrangian averaged vorticity deviation (Optical flow-LAVD) method is proposed. Methodology: We examined the flow within the right atrium (RA) of the participants’ hearts, by using a single set of scans pertaining to a slice at two-chamber short-axis orientation. Toward adequate extraction of the vortex ring characteristics, a novel approach driven by the Lagrangian averaged vorticity deviation (LAVD) was implemented and applied to characterize the trajectory integral associated with vorticity deviation and the spatial mean of rings, by using phase-contrast magnetic resonance imaging (PC-MRI) datasets as a case study. To interpolate the time frames between every larger discrete frame and minimize the error caused by constructing a continuous velocity field for the integral process of LAVD, we implemented the optical flow as an interpolator and introduced the backward warping as an intermediate frame synthesis basis, which is then used to generate higher quality continuous velocity fields. Results: Our analytical study results showed that the proposed Optical flow-LAVD method can accurately identify vortex ring and continuous velocity fields, based on optical flow information, for yielding high reconstruction outcomes. Compared with the linear interpolation and phased-based frame interpolation methods, our proposed algorithm can generate more accurate synthesized PC-MRI. Conclusion: This study has developed a novel Optical flow-LAVD model to accurately identify cardiac vortex rings, and minimize the associated errors caused by the construction of a continuous velocity field. Our paper presents a superior vortex characteristics detection method that may potentially aid the understanding of medical experts on the dynamics of blood flow within the heart.
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Affiliation(s)
- Ke Yang
- Key Laboratory of Metallurgical Equipment and Control Technology, Ministry of Education, Wuhan University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Mechanical Transmission and Manufacturing Engineering, Wuhan University of Science and Technology, Wuhan, China
| | - Shiqian Wu
- School of Information Science and Engineering, Wuhan University of Science and Technology, Wuhan, China
| | - Oluwarotimi W Samuel
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hui Zhang
- Ultrasound Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dhanjoo N Ghista
- University 2020 Foundation, Inc., California City, CA, United States
| | - Di Yang
- Key Laboratory of Metallurgical Equipment and Control Technology, Ministry of Education, Wuhan University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Mechanical Transmission and Manufacturing Engineering, Wuhan University of Science and Technology, Wuhan, China
| | - Kelvin K L Wong
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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200
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Liu CY. Editorial for "Whole-Heart 4D Flow MRI for Evaluation of Normal and Regurgitant Valvular Flow: A Quantitative Comparison Between Pseudo-Spiral Sampling and EPI Readout". J Magn Reson Imaging 2021; 55:1131-1132. [PMID: 34510636 DOI: 10.1002/jmri.27919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chia-Ying Liu
- Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, 324-8550, Japan
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