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Gerhardt P, Shehu N, Ferrari I, Hüllebrandt M, Hennemuth A, Martinoff S, Ewert P, Stern H, Meierhofer C. Quantifying aortic valve regurgitation in patients with congenital aortic valve disease by 2D and 4D flow magnetic resonance analysis. Int J Cardiol 2024; 408:132084. [PMID: 38653434 DOI: 10.1016/j.ijcard.2024.132084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/11/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND In congenital aortic valve disease, quantifying aortic regurgitation (AR) varies by the measurement site. Our study aimed to identify the optimal site for AR assessment using 2D and 4D MR flow measurements, with a focus on vortices. METHODS We retrospectively analysed 31 patients with congenital aortic valve disease, performing 2D and 4D MR flow measurements at the aortic valve, sinotubular junction (STJ), ascending aorta (AAo), and using midpulmonary artery measurements as a reference. We assessed percentage AR and net forward volumes, calculated linear correlations, and plotted Bland-Altman plots. Net forward flow at all aortic sites were correlated with the main pulmonary artery. Differences in AR between 2D and 4D flows were linked to vortices detected by 4D streamlines. RESULTS The best agreement in % AR between 2D and 4D flows was at the aortic valve (mean difference 4D2D -2.9%, limits of agreement 8.7% to -14.3%; r2 = 0.7). Correlations weakened at STJ and AAo. Vortices in the ascending aorta led to AR overestimation in 2D measurements. Net forward flow at the aortic valve by 4D flow correlated closer with main pulmonary artery than did 2D flow. (Mean difference for 2D and 4D MR flow 7.5 ml and 4.2 ml, respectively). CONCLUSIONS For congenital aortic valve disease, the most accurate AR quantification occurs at the aortic valve using 2D and 4D MR flow. Notably, vortices in the ascending aorta can result in AR overestimation with 2D MR flow.
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Affiliation(s)
- Philip Gerhardt
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Nerejda Shehu
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Irene Ferrari
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Germany; Borgo Trento Hospital, Pediatric Cardiology and Congenital Heart Disease, University of Verona, Verona, Italy
| | - Markus Hüllebrandt
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
| | - Anja Hennemuth
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
| | - Stefan Martinoff
- Radiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Peter Ewert
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Germany.
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Germany
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Riva A, Saitta S, Sturla F, Disabato G, Tondi L, Camporeale A, Giese D, Castelvecchio S, Menicanti L, Redaelli A, Lombardi M, Votta E. Left ventricle diastolic vortex ring characterization in ischemic cardiomyopathy: insight into atrio-ventricular interplay. Med Biol Eng Comput 2024:10.1007/s11517-024-03154-4. [PMID: 38954265 DOI: 10.1007/s11517-024-03154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
Diastolic vortex ring (VR) plays a key role in the blood-pumping function exerted by the left ventricle (LV), with altered VR structures being associated with LV dysfunction. Herein, we sought to characterize the VR diastolic alterations in ischemic cardiomyopathy (ICM) patients with systo-diastolic LV dysfunction, as compared to healthy controls, in order to provide a more comprehensive understanding of LV diastolic function. 4D Flow MRI data were acquired in ICM patients (n = 15) and healthy controls (n = 15). The λ2 method was used to extract VRs during early and late diastolic filling. Geometrical VR features, e.g., circularity index (CI), orientation (α), and inclination with respect to the LV outflow tract (ß), were extracted. Kinetic energy (KE), rate of viscous energy loss ( EL ˙ ), vorticity (W), and volume (V) were computed for each VR; the ratios with the respective quantities computed for the entire LV were derived. At peak E-wave, the VR was less circular (p = 0.032), formed a smaller α with the LV long-axis (p = 0.003) and a greater ß (p = 0.002) in ICM patients as compared to controls. At peak A-wave, CI was significantly increased (p = 0.034), while α was significantly smaller (p = 0.016) and β was significantly increased (p = 0.036) in ICM as compared to controls. At both peak E-wave and peak A-wave,EL ˙ VR / EL ˙ LV , WVR/WLV, and VVR/VLV significantly decreased in ICM patients vs. healthy controls. KEVR/VVR showed a significant decrease in ICM patients with respect to controls at peak E-wave, while VVR remained comparable between normal and pathologic conditions. In the analyzed ICM patients, the diastolic VRs showed alterations in terms of geometry and energetics. These derangements might be attributed to both structural and functional alterations affecting the infarcted wall region and the remote myocardium.
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Affiliation(s)
- Alessandra Riva
- 3D and Computer Simulation Laboratory, IRCCS, Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Simone Saitta
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS, Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Italy.
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy.
| | - Giandomenico Disabato
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | | | - 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
- 3D and Computer Simulation Laboratory, IRCCS, Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
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Takei Y, Miyazaki S, Suzuki K, Saito S, Oogaki H, Muraoka Y, Ogasawara T, Tezuka M, Shibasaki I, Fukuda H. Hemodynamic predictors of negative false lumen remodeling after frozen elephant trunk for acute aortic dissection. Gen Thorac Cardiovasc Surg 2024; 72:376-386. [PMID: 37948001 PMCID: PMC11127806 DOI: 10.1007/s11748-023-01984-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/18/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE We evaluated the blood flow within the downstream aortic false lumen after frozen elephant trunk repair for acute aortic dissection and identified hemodynamic predictors of false lumen expansion and negative false lumen remodeling using four-dimensional flow magnetic resonance imaging. METHODS Thirty-one patients (Stanford type A, n = 28; Stanford type B, n = 3) with patent false lumen who underwent frozen elephant trunk procedures for acute aortic dissection were included in this observational study. Each patient underwent computed tomography during the follow-up period and four-dimensional flow magnetic resonance imaging within 3 postoperative months. The false lumen volumetric expansion rate was calculated using computed tomography data. The direction and the rate of flow in the lower descending aortic false lumen were analyzed. Negative false lumen remodeling was defined as a volumetric increase of > 10% from the baseline volume. RESULTS Negative false lumen remodeling had developed in 6 of the 31 patients during the observation period. Most of the false lumen flows were biphasic during systole. The range between peak and nadir flow rates was associated with the false lumen volumetric expansion rate (β coefficient = 6.77; p < 0.01, R2 = 0.43). CONCLUSIONS The range between peak and nadir flow rates may serve as a hemodynamic predictor of negative false lumen remodeling, enabling further treatment for patients at risk of expansion in the downstream aorta.
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Affiliation(s)
- Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi, 321-0293, Japan.
| | | | | | | | - Hayato Oogaki
- Department of Radiology, Dokkyo Medical University Hospital, Mibu-machi, Tochigi, Japan
| | - Yuki Muraoka
- Department of Radiology, Dokkyo Medical University Hospital, Mibu-machi, Tochigi, Japan
| | - Takeshi Ogasawara
- Mathematics and Statistics Section, Department of Fundamental Education, Dokkyo Medical University, Mibu-machi, Tochigi, Japan
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi, 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi, 321-0293, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi, 321-0293, Japan
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Christierson L, Frieberg P, Lala T, Töger J, Liuba P, Revstedt J, Isaksson H, Hakacova N. Multi-Modal in Vitro Experiments Mimicking the Flow Through a Mitral Heart Valve Phantom. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00732-3. [PMID: 38782878 DOI: 10.1007/s13239-024-00732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Fluid-structure interaction (FSI) models are more commonly applied in medical research as computational power is increasing. However, understanding the accuracy of FSI models is crucial, especially in the context of heart valve disease in patient-specific models. Therefore, this study aimed to create a multi-modal benchmarking data set for cardiac-inspired FSI models, based on clinically important parameters, such as the pressure, velocity, and valve opening, with an in vitro phantom setup. METHOD An in vitro setup was developed with a 3D-printed phantom mimicking the left heart, including a deforming mitral valve. A range of pulsatile flows were created with a computer-controlled motor-and-pump setup. Catheter pressure measurements, magnetic resonance imaging (MRI), and echocardiography (Echo) imaging were used to measure pressure and velocity in the domain. Furthermore, the valve opening was quantified based on cine MRI and Echo images. RESULT The experimental setup, with 0.5% cycle-to-cycle variation, was successfully built and six different flow cases were investigated. Higher velocity through the mitral valve was observed for increased cardiac output. The pressure difference across the valve also followed this trend. The flow in the phantom was qualitatively assessed by the velocity profile in the ventricle and by streamlines obtained from 4D phase-contrast MRI. CONCLUSION A multi-modal set of data for validation of FSI models has been created, based on parameters relevant for diagnosis of heart valve disease. All data is publicly available for future development of computational heart valve models.
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Affiliation(s)
- Lea Christierson
- Department of Clinical Sciences Lund, Pediatric Heart Center, Skåne University Hospital, Lund University, Lund, Sweden.
- Department of Biomedical Engineering, Lund University, Lund, Sweden.
| | - Petter Frieberg
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Tania Lala
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Johannes Töger
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Petru Liuba
- Department of Clinical Sciences Lund, Pediatric Heart Center, Skåne University Hospital, Lund University, Lund, Sweden
| | - Johan Revstedt
- Department of Energy Science, Lund University, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Nina Hakacova
- Department of Clinical Sciences Lund, Pediatric Heart Center, Skåne University Hospital, Lund University, Lund, Sweden
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5
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Yang H, Hong K, Baraboo JJ, Fan L, Larsen A, Markl M, Robinson JD, Rigsby CK, Kim D. GRASP reconstruction amplified with view-sharing and KWIC filtering reduces underestimation of peak velocity in highly-accelerated real-time phase-contrast MRI: A preliminary evaluation in pediatric patients with congenital heart disease. Magn Reson Med 2024; 91:1965-1977. [PMID: 38084397 PMCID: PMC10950531 DOI: 10.1002/mrm.29974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE To develop a highly-accelerated, real-time phase contrast (rtPC) MRI pulse sequence with 40 fps frame rate (25 ms effective temporal resolution). METHODS Highly-accelerated golden-angle radial sparse parallel (GRASP) with over regularization may result in temporal blurring, which in turn causes underestimation of peak velocity. Thus, we amplified GRASP performance by synergistically combining view-sharing (VS) and k-space weighted image contrast (KWIC) filtering. In 17 pediatric patients with congenital heart disease (CHD), the conventional GRASP and the proposed GRASP amplified by VS and KWIC (or GRASP + VS + KWIC) reconstruction for rtPC MRI were compared with respect to clinical standard PC MRI in measuring hemodynamic parameters (peak velocity, forward volume, backward volume, regurgitant fraction) at four locations (aortic valve, pulmonary valve, left and right pulmonary arteries). RESULTS The proposed reconstruction method (GRASP + VS + KWIC) achieved better effective spatial resolution (i.e., image sharpness) compared with conventional GRASP, ultimately reducing the underestimation of peak velocity from 17.4% to 6.4%. The hemodynamic metrics (peak velocity, volumes) were not significantly (p > 0.99) different between GRASP + VS + KWIC and clinical PC, whereas peak velocity was significantly (p < 0.007) lower for conventional GRASP. RtPC with GRASP + VS + KWIC also showed the ability to assess beat-to-beat variation and detect the highest peak among peaks. CONCLUSION The synergistic combination of GRASP, VS, and KWIC achieves 25 ms effective temporal resolution (40 fps frame rate), while minimizing the underestimation of peak velocity compared with conventional GRASP.
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Affiliation(s)
- Huili Yang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - KyungPyo Hong
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Lexiaozi Fan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Andrine Larsen
- Department of Biomedical Engineering, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Joshua D Robinson
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Zvolanek KM, Moore JE, Jarvis K, Moum SJ, Bright MG. Macrovascular blood flow and microvascular cerebrovascular reactivity are regionally coupled in adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.26.590312. [PMID: 38746187 PMCID: PMC11092525 DOI: 10.1101/2024.04.26.590312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Cerebrovascular imaging assessments are particularly challenging in adolescent cohorts, where not all modalities are appropriate, and rapid brain maturation alters hemodynamics at both macro- and microvascular scales. In a preliminary sample of healthy adolescents (n=12, 8-25 years), we investigated relationships between 4D flow MRI-derived blood velocity and blood flow in bilateral anterior, middle, and posterior cerebral arteries and BOLD cerebrovascular reactivity in associated vascular territories. As hypothesized, higher velocities in large arteries are associated with an earlier response to a vasodilatory stimulus (cerebrovascular reactivity delay) in the downstream territory. Higher blood flow through these arteries is associated with a larger BOLD response to a vasodilatory stimulus (cerebrovascular reactivity amplitude) in the associated territory. These trends are consistent in a case study of adult moyamoya disease. In our small adolescent cohort, macrovascular-microvascular relationships for velocity/delay and flow/CVR change with age, though underlying mechanisms are unclear. Our work emphasizes the need to better characterize this key stage of human brain development, when cerebrovascular hemodynamics are changing, and standard imaging methods offer limited insight into these processes. We provide important normative data for future comparisons in pathology, where combining macro- and microvascular assessments may better help us prevent, stratify, and treat cerebrovascular disease.
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Pionteck A, Abderezaei J, Fillingham P, Chuang YC, Sakai Y, Belani P, Rigney B, De Leacy R, Fifi JT, Chien A, Colby GP, Jahan R, Duckwiler G, Sayre J, Holdsworth SJ, Mossa-Basha M, Levitt MR, Mocco J, Kurt M, Nael K. Intracranial aneurysm wall displacement depicted by amplified Flow predicts growth. J Neurointerv Surg 2024:jnis-2023-021227. [PMID: 38320850 DOI: 10.1136/jnis-2023-021227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Abnormal intracranial aneurysm (IA) wall motion has been associated with IA growth and rupture. Recently, a new image processing algorithm called amplified Flow (aFlow) has been used to successfully track IA wall motion by combining the amplification of cine and four-dimensional (4D) Flow MRI. We sought to apply aFlow to assess wall motion as a potential marker of IA growth in a paired-wise analysis of patients with growing versus stable aneurysms. METHODS In this retrospective case-control study, 10 patients with growing IAs and a matched cohort of 10 patients with stable IAs who had baseline 4D Flow MRI were included. The aFlow was used to amplify and extract IA wall displacements from 4D Flow MRI. The associations of aFlow parameters with commonly used risk factors and morphometric features were assessed using paired-wise univariate and multivariate analyses. RESULTS aFlow quantitative results showed significantly (P=0.035) higher wall motion displacement depicted by mean±SD 90th% values of 2.34±0.72 in growing IAs versus 1.39±0.58 in stable IAs with an area under the curve of 0.85. There was also significantly (P<0.05) higher variability of wall deformation across IA geometry in growing versus stable IAs depicted by the dispersion variables including 121-150% larger standard deviation ([Formula: see text]) and 128-161% wider interquartile range [Formula: see text]. CONCLUSIONS aFlow-derived quantitative assessment of IA wall motion showed greater wall motion and higher variability of wall deformation in growing versus stable IAs.
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Affiliation(s)
- Aymeric Pionteck
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Javid Abderezaei
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Patrick Fillingham
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ya-Chen Chuang
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Yu Sakai
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Puneet Belani
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Brian Rigney
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aichi Chien
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Reza Jahan
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Gary Duckwiler
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - James Sayre
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Mahmud Mossa-Basha
- Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mehmet Kurt
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Kambiz Nael
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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Bracamonte J, Truong U, Wilson J, Soares J. Correction of phase offset errors and quantification of background noise, signal-to-noise ratio, and encoded-displacement uncertainty on DENSE MRI for kinematics of the descending thoracic and abdominal aorta. Magn Reson Imaging 2024; 106:91-103. [PMID: 38092083 PMCID: PMC10842810 DOI: 10.1016/j.mri.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
Displacement encoding with stimulated echoes (DENSE) MRI is a phase contrast technique that allows the encoding of tissue displacement into the phase of the magnetic resonance signal. Recent developments in this technique allow the imaging of relatively thin structures such as the aortic wall. Quantifying background noise associated to DENSE MRI is required to assess the uncertainty of derived displacement measurements and for the design and implementation of adequate noise-reduction techniques. Although noise and error management of cardiac DENSE MRI has been previously studied, developments for aortic applications are scarce. Herein, we evaluate the noise and uncertainty of DENSE MRI scans at three different locations along the descending aorta: the distal aortic arch (DAA), the descending thoracic aorta (DTA), and infrarenal abdominal aorta (IAA). Additionally, we analyze three datasets from in vitro validation experiments with polyvinyl alcohol phantoms. We implement and evaluate the effectiveness of an offset-error correction algorithm and noise filtering techniques on DENSE MRI for aortic motion applications. Our results show that the phase signal of pixels composing the static background was normally distributed, centered on average at 0.003 ± 0.02 rad and - 0.02 ± 0.024 rad for each phase directions, suggesting that background noise is random, isotropic, and DENSE MRI has little offset errors. However, background signal noise significantly increased with elapsed time of the cardiac cycle; and was spatially heterogeneous consistently increased towards the anterior space. Background noise showed no significant differences between the 3 aortic locations and the in vitro experiments. However, SNR depended on the displacement of the region of interest, in consequence it was found significantly larger at DAA (16.7 ± 8.5, p = 0.003) and DTA (15.4 ± 7.6, p = 0.008) than at the IAA (8.0 ± 4.1), but not significantly different than the SNR of in vitro experiments (8.0 ± 3.7), and had an overall average of 13 ± 7. The applied methods significantly reduced the offset error and effect of noise on the estimation of encoded displacements. Finally, this analysis suggests that the implemented DENSE MRI protocol is adequate to assess the motion of healthy human aortas. However, the relative effect of noise increased considerably on the analysis of an ageing or diseased aortas with impaired mobility, calling for further analyses on pathologically stiffened aortas.
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Affiliation(s)
- Johane Bracamonte
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Uyen Truong
- Department of Pediatrics, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - John Wilson
- Department of Biomedical Engineering and Pauley Heart Center, Virginia Commonwealth University, VA, USA
| | - Joao Soares
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA.
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9
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Moscatelli S, Gatehouse P, Krupickova S, Mohiaddin R, Voges I, Giese D, Nielles-Vallespin S, Pennell DJ. Impact of compressed sensing (CS) acceleration of two-dimensional (2D) flow sequences in clinical paediatric cardiovascular magnetic resonance (CMR). MAGMA (NEW YORK, N.Y.) 2023; 36:869-876. [PMID: 37202654 PMCID: PMC10667407 DOI: 10.1007/s10334-023-01098-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Two-dimensional (2D) through-plane phase-contrast (PC) cine flow imaging assesses shunts and valve regurgitations in paediatric CMR and is considered the reference standard for Clinical quantification of blood Flow (COF). However, longer breath-holds (BH) can reduce compliance with possibly large respiratory manoeuvres altering flow. We hypothesize that reduced BH time by application of CS (Short BH quantification of Flow) (SBOF) retains accuracy while enabling faster, potentially more reliable flows. We investigate the variance between COF and SBOF cine flows. METHODS Main pulmonary artery (MPA) and sinotubular junction (STJ) planes were acquired at 1.5 T in paediatric patients by COF and SBOF. RESULTS 21 patients (mean age 13.9, 10-17y) were enrolled. The BH times were COF mean 11.7 s (range 8.4-20.9 s) vs SBOF mean 6.5 s (min 3.6-9.1 s). The differences and 95% CI between the COF and SBOF flows were LVSV -1.43 ± 13.6(ml/beat), LVCO 0.16 ± 1.35(l/min) and RVSV 2.95 ± 12.3(ml/beat), RVCO 0.27 ± 0.96(l/min), QP/QS were SV 0.04 ± 0.19, CO 0.02 ± 0.23. Variability between COF and SBOF did not exceed intrasession variation of COF. CONCLUSION SBOF reduces breath-hold duration to 56% of COF. RV flow by SBOF was biased compared to COF. The variation (95% CI) between COF and SBOF was similar to the COF intrasession test-retest 95% CI.
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Affiliation(s)
- Sara Moscatelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - Peter Gatehouse
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, England.
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
| | - Raad Mohiaddin
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | - Sonia Nielles-Vallespin
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
| | - Dudley J Pennell
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
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10
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Lee J, Huh H, Scott MB, Elbaz MSM, Puthumana JJ, McCarthy P, Malaisrie SC, Markl M, Thomas JD, Barker AJ. Valvular and ascending aortic hemodynamics of the On-X aortic valved conduit by same-day echocardiography and 4D flow MRI. Front Cardiovasc Med 2023; 10:1256420. [PMID: 38034383 PMCID: PMC10682731 DOI: 10.3389/fcvm.2023.1256420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
This study aims to assess whether the On-X aortic valved conduit better restores normal valvular and ascending aortic hemodynamics than other commonly used bileaflet mechanical valved conduit prostheses from St. Jude Medical and Carbomedics by using same-day transthoracic echocardiography (TTE) and 4D flow magnetic resonance imaging (MRI) examinations. TTE and 4D flow MRI were performed back-to-back in 10 patients with On-X, six patients with St. Jude (two) and Carbomedics (four) prostheses, and 36 healthy volunteers. TTE evaluated valvular hemodynamic parameters: transvalvular peak velocity (TPV), mean and peak transvalvular pressure gradient (TPG), and effective orifice area (EOA). 4D flow MRI evaluated the peak systolic 3D viscous energy loss rate (VELR) density and mean vorticity magnitude in the ascending aorta (AAo). While higher TPV and mean and peak TPG were recorded in all patients compared to healthy subjects, the values in On-X patients were closer to those in healthy subjects (TPV 1.9 ± 0.3 vs. 2.2 ± 0.3 vs. 1.2 ± 0.2 m/s, mean TPG 7.4 ± 1.9 vs. 9.2 ± 2.3 vs. 3.1 ± 0.9 mmHg, peak TPG 15.3 ± 5.2 vs. 18.9 ± 5.2 vs. 6.1 ± 1.8 mmHg, p < 0.001). Likewise, while higher VELR density and mean vorticity magnitude were recorded in all patients than in healthy subjects, the values in On-X patients were closer to those in healthy subjects (VELR: 50.6 ± 20.1 vs. 89.8 ± 35.2 vs. 21.4 ± 9.2 W/m3, p < 0.001) and vorticity (147.6 ± 30.0 vs. 191.2 ± 26.0 vs. 84.6 ± 20.5 s-1, p < 0.001). This study demonstrates that the On-X aortic valved conduit may produce less aberrant hemodynamics in the AAo while maintaining similar valvular hemodynamics to St. Jude Medical and Carbomedics alternatives.
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Affiliation(s)
- Jeesoo Lee
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Hyungkyu Huh
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Michael B. Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Mohammed S. M. Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jyothy J. Puthumana
- Department of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Patrick McCarthy
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - S. Christopher Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - James D. Thomas
- Department of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alex J. Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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DiCarlo AL, Haji-Valizadeh H, Passman R, Greenland P, McCarthy P, Lee DC, Kim D, Markl M. Assessment of Beat-To-Beat Variability in Left Atrial Hemodynamics Using Real Time Phase Contrast MRI in Patients With Atrial Fibrillation. J Magn Reson Imaging 2023; 58:763-771. [PMID: 36468562 PMCID: PMC10239789 DOI: 10.1002/jmri.28550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hemodynamic assessment of left atrial (LA) flow using phase contrast MRI provides insight into thromboembolic risk in atrial fibrillation (AF). However, conventional flow imaging techniques are averaged over many heartbeats. PURPOSE To evaluate beat-to-beat variability and LA hemodynamics in patients with AF using real time phase contrast (RTPC) MRI. STUDY TYPE Prospective. SUBJECTS Thirty-five patients with history of AF (68 ± 10 years, nine female), 10 healthy controls (57 ± 19 years, four female). FIELD STRENGTH/SEQUENCE 5T, 2D RTPC with through-plane velocity-encoded gradient echo sequence and 4D flow MRI with three-directional velocity-encoded gradient echo sequence. ASSESSMENT RTPC was continuously acquired for a mid-LA slice in all subjects. 4D flow data were interpolated at the RTPC location and normally projected for comparison with RTPC. RR intervals extracted from RTPC were used to calculate heart rate variability (HRV = interquartile range over median × 100%). Patients were classified into low (<9.7%) and high (>9.7%) HRV groups. LA peak/mean velocity and stasis (%velocities < 5.8 cm/sec) were calculated from segmented 2D images. Variability in RTPC flow metrics was quantified by coefficient of variation (CV) over all cycles. STATISTICAL TESTS Pearson's correlation coefficient (r), Bland-Altman analysis, Kruskal-Wallis test. A P value < 0.05 was considered statistically significant. RESULTS RTPC and 4D flow measurements were strongly/significantly correlated for all hemodynamic parameters (R2 = 0.75-0.83) in controls. Twenty-four patients had low HRV (mean = 4 ± 2%) and 11 patients had high HRV (27 ± 9%). In patients, increased HRV was significantly correlated with CV of peak velocity (r = 0.67), mean velocity (r = 0.51), and stasis (r = 0.41). A stepwise decrease in peak/mean velocity and increase in stasis was observed when comparing controls vs. low HRV vs. high HRV groups. Mean velocity and stasis differences were significant for control vs. high HRV groups. CONCLUSIONS RTPC may be suitable for assessing the impact of HRV on hemodynamics and provide insight for AF management in highly arrhythmic patients. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Amanda L DiCarlo
- Department of Radiology, Northwestern University Feinberg School of Medicine
| | - Hassan Haji-Valizadeh
- Department of Radiology, Northwestern University Feinberg School of Medicine
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering
| | - Rod Passman
- Department of Cardiology, Northwestern University Feinberg School of Medicine
| | - Philip Greenland
- Department of Cardiology, Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Patrick McCarthy
- Department of Cardiothoracic Surgery, Northwestern University Feinberg School of Medicine
| | - Daniel C Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering
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Wieben O, Roberts GS, Corrado PA, Johnson KM, Roldán-Alzate A. Four-Dimensional Flow MR Imaging: Technique and Advances. Magn Reson Imaging Clin N Am 2023; 31:433-449. [PMID: 37414470 DOI: 10.1016/j.mric.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
4D Flow MRI is an advanced imaging technique for comprehensive non-invasive assessment of the cardiovascular system. The capture of the blood velocity vector field throughout the cardiac cycle enables measures of flow, pulse wave velocity, kinetic energy, wall shear stress, and more. Advances in hardware, MRI data acquisition and reconstruction methodology allow for clinically feasible scan times. The availability of 4D Flow analysis packages allows for more widespread use in research and the clinic and will facilitate much needed multi-center, multi-vendor studies in order to establish consistency across scanner platforms and to enable larger scale studies to demonstrate clinical value.
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Affiliation(s)
- Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA.
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705-2275, USA
| | - Philip A Corrado
- Accuray Incorporated, 1414 Raleigh Road, Suite 330, DurhamChapel Hill, NC 27517, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Room: 3035, 1513 University Avenue, Madison, WI 53706, USA; Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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13
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Ramaekers MJFG, Westenberg JJM, Adriaans BP, Nijssen EC, Wildberger JE, Lamb HJ, Schalla S. A clinician's guide to understanding aortic 4D flow MRI. Insights Imaging 2023; 14:114. [PMID: 37395817 DOI: 10.1186/s13244-023-01458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
Four-dimensional flow magnetic resonance imaging is an emerging technique which may play a role in diagnosis and risk-stratification of aortic disease. Some knowledge of flow dynamics and related parameters is necessary to understand and apply this technique in clinical workflows. The purpose of the current review is to provide a guide for clinicians to the basics of flow imaging, frequently used flow-related parameters, and their relevance in the context of aortic disease.Clinical relevance statement Understanding normal and abnormal aortic flow could improve clinical care in patients with aortic disease.
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Affiliation(s)
- Mitch J F G Ramaekers
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bouke P Adriaans
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Estelle C Nijssen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Carter KJ, Ward AT, Kellawan JM, Harrell JW, Peltonen GL, Roberts GS, Al-Subu A, Hagen SA, Serlin RC, Eldridge MW, Wieben O, Schrage WG. Reduced basal macrovascular and microvascular cerebral blood flow in young adults with metabolic syndrome: potential mechanisms. J Appl Physiol (1985) 2023; 135:94-108. [PMID: 37199780 PMCID: PMC10292973 DOI: 10.1152/japplphysiol.00688.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/26/2023] [Accepted: 05/13/2023] [Indexed: 05/19/2023] Open
Abstract
Ninety-million Americans suffer metabolic syndrome (MetSyn), increasing the risk of diabetes and poor brain outcomes, including neuropathology linked to lower cerebral blood flow (CBF), predominantly in anterior regions. We tested the hypothesis that total and regional CBF is lower in MetSyn more so in the anterior brain and explored three potential mechanisms. Thirty-four controls (25 ± 5 yr) and 19 MetSyn (30 ± 9 yr), with no history of cardiovascular disease/medications, underwent four-dimensional flow magnetic resonance imaging (MRI) to quantify macrovascular CBF, whereas arterial spin labeling quantified brain perfusion in a subset (n = 38/53). Contributions of cyclooxygenase (COX; n = 14), nitric oxide synthase (NOS, n = 17), or endothelin receptor A signaling (n = 13) were tested with indomethacin, NG-monomethyl-L-arginine (L-NMMA), and Ambrisentan, respectively. Total CBF was 20 ± 16% lower in MetSyn (725 ± 116 vs. 582 ± 119 mL/min, P < 0.001). Anterior and posterior brain regions were 17 ± 18% and 30 ± 24% lower in MetSyn; reductions were not different between regions (P = 0.112). Global perfusion was 16 ± 14% lower in MetSyn (44 ± 7 vs. 36 ± 5 mL/100 g/min, P = 0.002) and regionally in frontal, occipital, parietal, and temporal lobes (range 15-22%). The decrease in CBF with L-NMMA (P = 0.004) was not different between groups (P = 0.244, n = 14, 3), and Ambrisentan had no effect on either group (P = 0.165, n = 9, 4). Interestingly, indomethacin reduced CBF more in Controls in the anterior brain (P = 0.041), but CBF decrease in posterior was not different between groups (P = 0.151, n = 8, 6). These data indicate that adults with MetSyn exhibit substantially reduced brain perfusion without regional differences. Moreover, this reduction is not due to loss of NOS or gain of ET-1 signaling but rather a loss of COX vasodilation.NEW & NOTEWORTHY We tested the impact of insulin resistance (IR) on resting cerebral blood flow (CBF) in adults with metabolic syndrome (MetSyn). Using MRI and research pharmaceuticals to study the role of NOS, ET-1, or COX signaling, we found that adults with MetSyn exhibit substantially lower CBF that is not explained by changes in NOS or ET-1 signaling. Interestingly, adults with MetSyn show a loss of COX-mediated vasodilation in the anterior but not posterior circulation.
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Affiliation(s)
- Katrina J Carter
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
| | - Aaron T Ward
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
| | - J Mikhail Kellawan
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma, United States
| | - John W Harrell
- 711th Human Performance Wing, Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, Ohio, United States
| | - Garrett L Peltonen
- School of Nursing and Kinesiology, Western New Mexico University, Silver City, New Mexico, United States
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, United States
| | - Awni Al-Subu
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Scott A Hagen
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Ronald C Serlin
- Department of Educational Psychology, University of Wisconsin, Madison, Wisconsin, United States
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, United States
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, United States
| | - William G Schrage
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
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15
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van Amerom JFP, Goolaub DS, Schrauben EM, Sun L, Macgowan CK, Seed M. Fetal cardiovascular blood flow MRI: techniques and applications. Br J Radiol 2023; 96:20211096. [PMID: 35687661 PMCID: PMC10321246 DOI: 10.1259/bjr.20211096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/11/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
Fetal cardiac MRI is challenging due to fetal and maternal movements as well as the need for a reliable cardiac gating signal and high spatiotemporal resolution. Ongoing research and recent technical developments to address these challenges show the potential of MRI as an adjunct to ultrasound for the assessment of the fetal heart and great vessels. MRI measurements of blood flow have enabled the assessment of normal fetal circulation as well as conditions with disrupted circulations, such as congenital heart disease, along with associated organ underdevelopment and hemodynamic instability. This review provides details of the techniques used in fetal cardiovascular blood flow MRI, including single slice and volumetric imaging sequences, post-processing and analysis, along with a summary of applications in human studies and animal models.
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Affiliation(s)
- Joshua FP van Amerom
- Division of Translational Medicine, SickKids Research Institute, Toronto, Canada
| | | | - Eric M Schrauben
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Srinivas S, Masutani E, Norbash A, Hsiao A. Deep learning phase error correction for cerebrovascular 4D flow MRI. Sci Rep 2023; 13:9095. [PMID: 37277401 DOI: 10.1038/s41598-023-36061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/29/2023] [Indexed: 06/07/2023] Open
Abstract
Background phase errors in 4D Flow MRI may negatively impact blood flow quantification. In this study, we assessed their impact on cerebrovascular flow volume measurements, evaluated the benefit of manual image-based correction, and assessed the potential of a convolutional neural network (CNN), a form of deep learning, to directly infer the correction vector field. With IRB waiver of informed consent, we retrospectively identified 96 MRI exams from 48 patients who underwent cerebrovascular 4D Flow MRI from October 2015 to 2020. Flow measurements of the anterior, posterior, and venous circulation were performed to assess inflow-outflow error and the benefit of manual image-based phase error correction. A CNN was then trained to directly infer the phase-error correction field, without segmentation, from 4D Flow volumes to automate correction, reserving from 23 exams for testing. Statistical analyses included Spearman correlation, Bland-Altman, Wilcoxon-signed rank (WSR) and F-tests. Prior to correction, there was strong correlation between inflow and outflow (ρ = 0.833-0.947) measurements with the largest discrepancy in the venous circulation. Manual phase error correction improved inflow-outflow correlation (ρ = 0.945-0.981) and decreased variance (p < 0.001, F-test). Fully automated CNN correction was non-inferior to manual correction with no significant differences in correlation (ρ = 0.971 vs ρ = 0.982) or bias (p = 0.82, Wilcoxon-Signed Rank test) of inflow and outflow measurements. Residual background phase error can impair inflow-outflow consistency of cerebrovascular flow volume measurements. A CNN can be used to directly infer the phase-error vector field to fully automate phase error correction.
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Affiliation(s)
- Shanmukha Srinivas
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA
- Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Evan Masutani
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA
| | - Alexander Norbash
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA
| | - Albert Hsiao
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
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Huang A, Roberts GS, Roldán-Alzate A, Wieben O, Reeder SB, Oechtering TH. Reference values for 4D flow magnetic resonance imaging of the portal venous system. Abdom Radiol (NY) 2023; 48:2049-2059. [PMID: 37016247 PMCID: PMC10518803 DOI: 10.1007/s00261-023-03892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The purpose of this work was to establish normal reference values for 4D flow MRI-derived flow, velocity, and vessel diameters, and to define characteristic flow patterns in the portal venous system of healthy adult subjects. METHODS For this retrospective study, we screened all available 4D flow MRI exams of the upper abdomen in healthy adults acquired at our institution between 2012 and 2022 at either 1.5 T or 3.0 T MRI after ≥ 5 h fasting. Flow, velocity, and effective diameter were quantified in the 8 planes in the portal venous system (splenic vein, superior mesenteric vein, main, right, and left portal veins). Vessel delineation was manually adjusted over time. Reference ranges for were defined as the mean ± 2 standard deviations. Three readers noted helical and vortical flow on time-resolved pathline visualizations. Conservation of mass flow analysis was performed for quality assurance. RESULTS We included 44 healthy subjects (26 female, 18-74 years) in the analysis. We report reference values for mean and peak flow, mean velocity, and vessel diameter in the healthy portal vein using 4D flow MRI. Normal flow patterns in the portal vein included faint helical (66%) or linear flow (34%). Conservation of mass analysis demonstrated a relative error of 1.1 ± 4.6% standard deviation (SD) at the splenomesenteric confluence and - 1.4 ± 4.1% SD at the portal bifurcation. CONCLUSION We have reported normal hemodynamic values that are necessary baseline data for emerging clinical applications of 4D flow MRI in the portal venous system. Results are consistent with previously published values from smaller cohorts.
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Affiliation(s)
- Andrew Huang
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Thekla H Oechtering
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
- Department of Radiology and Nuclear Medicine, Universität zu Lübeck, Lübeck, Germany.
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Kilinc O, Chu S, Baraboo J, Weiss EK, Engel J, Maroun A, Giese D, Jin N, Chow K, Bi X, Davids R, Mehta C, Malaisrie SC, Hoel A, Carr J, Markl M, Allen BD. Hemodynamic Evaluation of Type B Aortic Dissection Using Compressed Sensing Accelerated 4D Flow MRI. J Magn Reson Imaging 2023; 57:1752-1763. [PMID: 36148924 PMCID: PMC10033465 DOI: 10.1002/jmri.28432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND 4D Flow MRI is a quantitative imaging technique to evaluate blood flow patterns; however, it is unclear how compressed sensing (CS) acceleration would impact aortic hemodynamic quantification in type B aortic dissection (TBAD). PURPOSE To investigate CS-accelerated 4D Flow MRI performance compared to GRAPP-accelerated 4D Flow MRI (GRAPPA) to evaluate aortic hemodynamics in TBAD. STUDY TYPE Prospective. POPULATION Twelve TBAD patients, two volunteers. FIELD STRENGTH/SEQUENCE 1.5T, 3D time-resolved cine phase-contrast gradient echo sequence. ASSESSMENT GRAPPA (acceleration factor [R] = 2) and two CS-accelerated (R = 7.7 [CS7.7] and 10.2 [CS10.2]) 4D Flow MRI scans were acquired twice for interscan reproducibility assessment. Voxelwise kinetic energy (KE), peak velocity (PV), forward flow (FF), reverse flow (RF), and stasis were calculated. Plane-based mid-lumen flows were quantified. Imaging times were recorded. TESTS Repeated measures analysis of variance, Pearson correlation coefficients (r), intraclass correlation coefficients (ICC). P < 0.05 indicated statistical significance. RESULTS The KE and FF in true lumen (TL) and PV in false lumen (FL) did not show difference among three acquisition types (P = 0.818, 0.065, 0.284 respectively). The PV and stasis in TL were higher, KE, FF, and RF in FL were lower, and stasis was higher in GRAPPA compared to CS7.7 and CS10.2. The RF was lower in GRAPPA compared to CS10.2. The correlation coefficients were strong in TL (r = [0.781-0.986]), and low to strong in FL (r = [0.347-0.948]). The ICC levels demonstrated moderate to excellent interscan reproducibility (0.732-0.989). The FF and net flow in mid-descending aorta TL were significantly different between CS7.7 and CS10.2. CONCLUSION CS-accelerated 4D Flow MRI has potential for clinical utilization with shorter scan times in TBAD. Our results suggest similar hemodynamic trends between acceleration types, but CS-acceleration impacts KE, FF, RF, and stasis more in FL. EVIDENCE LEVEL 1 Technical Efficacy: Stage 2.
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Affiliation(s)
- Ozden Kilinc
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Stanley Chu
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Justin Baraboo
- Department of Radiology, Northwestern University, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Elizabeth K. Weiss
- Department of Radiology, Northwestern University, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Joshua Engel
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Anthony Maroun
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Cleveland, Ohio
| | - Kelvin Chow
- Department of Radiology, Northwestern University, Chicago, Illinois
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Xiaoming Bi
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Rachel Davids
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Christopher Mehta
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, Illinois
| | | | - Andrew Hoel
- Department of Surgery (Vascular Surgery), Northwestern University, Chicago, Illinois
| | - James Carr
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Bradley D. Allen
- Department of Radiology, Northwestern University, Chicago, Illinois
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19
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Sun A, Zhao B, Zheng Y, Long Y, Wu P, Wang B, Li R, Wang H. Motion-resolved real-time 4D flow MRI with low-rank and subspace modeling. Magn Reson Med 2023; 89:1839-1852. [PMID: 36533875 DOI: 10.1002/mrm.29557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/01/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To develop a new motion-resolved real-time four-dimensional (4D) flow MRI method, which enables the quantification and visualization of blood flow velocities with three-directional flow encodings and volumetric coverage without electrocardiogram (ECG) synchronization and respiration control. METHODS An integrated imaging method is presented for real-time 4D flow MRI, which encompasses data acquisition, image reconstruction, and postprocessing. The proposed method features a specialized continuous ( k , t ) $$ \left(\mathbf{k},t\right) $$ -space acquisition scheme, which collects two sets of data (i.e., training data and imaging data) in an interleaved manner. By exploiting strong spatiotemporal correlation of 4D flow data, it reconstructs time-series images from highly-undersampled ( k , t ) $$ \left(\mathbf{k},t\right) $$ -space measurements with a low-rank and subspace model. Through data-binning-based postprocessing, it constructs a five-dimensional dataset (i.e., x-y-z-cardiac-respiratory), from which respiration-dependent flow information is further analyzed. The proposed method was evaluated in aortic flow imaging experiments with ten healthy subjects and two patients with atrial fibrillation. RESULTS The proposed method achieves 2.4 mm isotropic spatial resolution and 34.4 ms temporal resolution for measuring the blood flow of the aorta. For the healthy subjects, it provides flow measurements in good agreement with those from the conventional 4D flow MRI technique. For the patients with atrial fibrillation, it is able to resolve beat-by-beat pathological flow variations, which cannot be obtained from the conventional technique. The postprocessing further provides respiration-dependent flow information. CONCLUSION The proposed method enables high-resolution motion-resolved real-time 4D flow imaging without ECG gating and respiration control. It is able to resolve beat-by-beat blood flow variations as well as respiration-dependent flow information.
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Affiliation(s)
- Aiqi Sun
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Bo Zhao
- Department of Biomedical Engineering, University of Texas at Austin, Austin, Texas, USA.,Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas, USA
| | | | - Yuliang Long
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Wu
- Philips Healthcare, Shanghai, China
| | - Bei Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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20
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Sache A, Reymond P, Brina O, Jung B, Farhat M, Vargas MI. Near-wall hemodynamic parameters quantification in in vitro intracranial aneurysms with 7 T PC-MRI. MAGMA (NEW YORK, N.Y.) 2023; 36:295-308. [PMID: 37072539 PMCID: PMC10140017 DOI: 10.1007/s10334-023-01082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Wall shear stress (WSS) and its derived spatiotemporal parameters have proven to play a major role on intracranial aneurysms (IAs) growth and rupture. This study aims to demonstrate how ultra-high field (UHF) 7 T phase contrast magnetic resonance imaging (PC-MRI) coupled with advanced image acceleration techniques allows a highly resolved visualization of near-wall hemodynamic parameters patterns in in vitro IAs, paving the way for more robust risk assessment of their growth and rupture. MATERIALS AND METHODS We performed pulsatile flow measurements inside three in vitro models of patient-specific IAs using 7 T PC-MRI. To this end, we built an MRI-compatible test bench, which faithfully reproduced a typical physiological intracranial flow rate in the models. RESULTS The ultra-high field 7 T images revealed WSS patterns with high spatiotemporal resolution. Interestingly, the high oscillatory shear index values were found in the core of low WSS vortical structures and in flow stream intersecting regions. In contrast, maxima of WSS occurred around the impinging jet sites. CONCLUSIONS We showed that the elevated signal-to-noise ratio arising from 7 T PC-MRI enabled to resolve high and low WSS patterns with a high degree of detail.
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Affiliation(s)
- Antoine Sache
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Farhat
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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21
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Roberts GS, Hoffman CA, Rivera-Rivera LA, Berman SE, Eisenmenger LB, Wieben O. Automated hemodynamic assessment for cranial 4D flow MRI. Magn Reson Imaging 2023; 97:46-55. [PMID: 36581214 PMCID: PMC9892280 DOI: 10.1016/j.mri.2022.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
Cranial 4D flow MRI post-processing typically involves manual user interaction which is time-consuming and associated with poor repeatability. The primary goal of this study is to develop a robust quantitative velocity tool (QVT) that utilizes threshold-based segmentation techniques to improve segmentation quality over prior approaches based on centerline processing schemes (CPS) that utilize k-means clustering segmentation. This tool also includes an interactive 3D display designed for simplified vessel selection and automated hemodynamic visualization and quantification. The performances of QVT and CPS were compared in vitro in a flow phantom and in vivo in 10 healthy participants. Vessel segmentations were compared with ground-truth computed tomography in vitro (29 locations) and manual segmentation in vivo (13 locations) using linear regression. Additionally, QVT and CPS MRI flow rates were compared to perivascular ultrasound flow in vitro using linear regression. To assess internal consistency of flow measures in vivo, conservation of flow was assessed at vessel junctions using linear regression and consistency of flow along vessel segments was analyzed by fitting a Gaussian distribution to a histogram of normalized flow values. Post-processing times were compared between the QVT and CPS using paired t-tests. Vessel areas segmented in vitro (CPS: slope = 0.71, r = 0.95 and QVT: slope = 1.03, r = 0.95) and in vivo (CPS: slope = 0.61, r = 0.96 and QVT: slope = 0.93, r = 0.96) were strongly correlated with ground-truth area measurements. However, CPS (using k-means segmentation) consistently underestimated vessel areas. Strong correlations were observed between QVT and ultrasound flow (slope = 0.98, r = 0.96) as well as flow at junctions (slope = 1.05, r = 0.98). Mean and standard deviation of flow along vessel segments was 9.33e-16 ± 3.05%. Additionally, the QVT demonstrated excellent interobserver agreement and significantly reduced post-processing by nearly 10 min (p < 0.001). By completely automating post-processing and providing an easy-to-use 3D visualization interface for interactive vessel selection and hemodynamic quantification, the QVT offers an efficient, robust, and repeatable means to analyze cranial 4D flow MRI. This software is freely available at: https://github.com/uwmri/QVT.
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Affiliation(s)
- Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA.
| | - Carson A Hoffman
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI 53792, USA.
| | - Sara E Berman
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI 53792, USA.
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366 Clinical Science Center, Madison, WI 53792, USA.
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA; Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366 Clinical Science Center, Madison, WI 53792, USA.
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22
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Wiseman SJ, Zhang JF, Gray C, Hamid C, Valdés Hernández MDC, Ballerini L, Thrippleton MJ, Manning C, Stringer M, Sleight E, Muñoz Maniega S, Morgan A, Cheng Y, Arteaga C, Jaime Garcia D, Clancy U, Doubal FN, Dhillon B, MacGillivray T, Wu YC, Wardlaw JM. Retinal capillary microvessel morphology changes are associated with vascular damage and dysfunction in cerebral small vessel disease. J Cereb Blood Flow Metab 2023; 43:231-240. [PMID: 36300327 PMCID: PMC9903216 DOI: 10.1177/0271678x221135658] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 01/24/2023]
Abstract
Cerebral small vessel disease (SVD) is a cause of stroke and dementia. Retinal capillary microvessels revealed by optical coherence tomography angiography (OCTA) are developmentally related to brain microvessels. We quantified retinal vessel density (VD) and branching complexity, investigating relationships with SVD lesions, white matter integrity on diffusion tensor imaging (DTI) and cerebrovascular reactivity (CVR) to CO2 in patients with minor stroke. We enrolled 123 patients (mean age 68.1 ± SD 9.9 years), 115 contributed retinal data. Right (R) and left (L) eyes are reported. After adjusting for age, eye disease, diabetes, blood pressure and image quality, lower VD remained associated with higher mean diffusivity (MD) (standardized β; R -0.16 [95%CI -0.32 to -0.01]) and lower CVR (L 0.17 [0.03 to 0.31] and R 0.19 [0.02 to 0.36]) in normal appearing white matter (NAWM). Sparser branching remained associated with sub-visible white matter damage shown by higher MD (R -0.24 [-0.08 to -0.40]), lower fractional anisotropy (FA) (L 0.17 [0.01 to 0.33]), and lower CVR (R 0.20 [0.02 to 0.38]) in NAWM. OCTA-derived metrics provide evidence of microvessel abnormalities that may underpin SVD lesions in the brain.
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Affiliation(s)
- Stewart J Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Calum Gray
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Charlene Hamid
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Maria del C Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Cameron Manning
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Michael Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
| | | | - Alasdair Morgan
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Yajun Cheng
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Department of Neurology, West China Hospital, Sichuan
University, Chengdu, China
| | - Carmen Arteaga
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Dany Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Una Clancy
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- NHS Lothian Princess Alexandra Eye Pavilion, UK
| | - Tom MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh,
Edinburgh, UK
- Edinburgh Imaging Facilities, Edinburgh Imaging, University of
Edinburgh, UK
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23
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Weiss EK, Jarvis K, Maroun A, Malaisrie SC, Mehta CK, McCarthy PM, Bonow RO, Avery RJ, Allen BD, Carr JC, Rigsby CK, Markl M. Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects. J Cardiovasc Magn Reson 2023; 25:3. [PMID: 36698129 PMCID: PMC9878800 DOI: 10.1186/s12968-022-00906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole. METHODS 510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole. RESULTS BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1). CONCLUSION 4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.
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Affiliation(s)
- Elizabeth K. Weiss
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Anthony Maroun
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Patrick M. McCarthy
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Robert O. Bonow
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Cynthia K. Rigsby
- Department of Medical Imaging, Lurie Children’s Hospital, Chicago, IL USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
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24
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Richards CE, Parker AE, Alfuhied A, McCann GP, Singh A. The role of 4-dimensional flow in the assessment of bicuspid aortic valve and its valvulo-aortopathies. Br J Radiol 2022; 95:20220123. [PMID: 35852109 PMCID: PMC9793489 DOI: 10.1259/bjr.20220123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Bicuspid aortic valve is the most common congenital cardiac malformation and the leading cause of aortopathy and aortic stenosis in younger patients. Aortic wall remodelling secondary to altered haemodynamic flow patterns, changes in peak velocity, and wall shear stress may be implicated in the development of aortopathy in the presence of bicuspid aortic valve and dysfunction. Assessment of these parameters as potential predictors of disease severity and progression is thus desirable. The anatomic and functional information acquired from 4D flow MRI can allow simultaneous visualisation and quantification of the pathological geometric and haemodynamic changes of the aorta. We review the current clinical utility of haemodynamic quantities including velocity, wall sheer stress and energy losses, as well as visual descriptors such as vorticity and helicity, and flow direction in assessing the aortic valve and associated aortopathies.
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Affiliation(s)
- Caryl Elizabeth Richards
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Alex E Parker
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Aseel Alfuhied
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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25
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Goolaub DS, Xu J, Schrauben EM, Marini D, Kingdom JC, Sled JG, Seed M, Macgowan CK. Volumetric Fetal Flow Imaging With Magnetic Resonance Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:2941-2952. [PMID: 35604966 DOI: 10.1109/tmi.2022.3176814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Fetal development relies on a complex circulatory network. Accurate assessment of flow distribution is important for understanding pathologies and potential therapies. In this paper, we demonstrate a method for volumetric imaging of fetal flow with magnetic resonance imaging (MRI). Fetal MRI faces challenges: small vascular structures, unpredictable motion, and inadequate traditional cardiac gating methods. Here, orthogonal multislice stacks are acquired with accelerated multidimensional radial phase contrast (PC) MRI. Slices are reconstructed into flow sensitive time-series images with motion correction and image-based cardiac gating. They are then combined into a dynamic volume using slice-to-volume reconstruction (SVR) while resolving interslice spatiotemporal coregistration. Compared to prior methods, this approach achieves higher spatiotemporal resolution ( 1×1×1 mm3, ~30 ms) with reduced scan time - important features for the quantification of flow through small fetal structures. Validation is demonstrated in adults by comparing SVR with 4D radial PCMRI (flow bias and limits of agreement: -1.1 ml/s and [-11.8 9.6] ml/s). Feasibility is demonstrated in late gestation fetuses by comparing SVR with 2D Cartesian PCMRI (flow bias and limits of agreement: -0.9 ml/min/kg and [-39.7 37.8] ml/min/kg). With SVR, we demonstrate complex flow pathways (such as parallel flow streams in the proximal inferior vena cava, preferential shunting of blood from the ductus venosus into the left atrium, and blood from the brain leaving the heart through the main pulmonary artery) for the first time in human fetal circulation. This method allows for comprehensive evaluation of the fetal circulation and enables future studies of fetal physiology.
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26
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Oscanoa JA, Middione MJ, Syed AB, Sandino CM, Vasanawala SS, Ennis DB. Accelerated two-dimensional phase-contrast for cardiovascular MRI using deep learning-based reconstruction with complex difference estimation. Magn Reson Med 2022; 89:356-369. [PMID: 36093915 DOI: 10.1002/mrm.29441] [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: 05/19/2022] [Revised: 07/16/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To develop and validate a deep learning-based reconstruction framework for highly accelerated two-dimensional (2D) phase contrast (PC-MRI) data with accurate and precise quantitative measurements. METHODS We propose a modified DL-ESPIRiT reconstruction framework for 2D PC-MRI, comprised of an unrolled neural network architecture with a Complex Difference estimation (CD-DL). CD-DL was trained on 155 fully sampled 2D PC-MRI pediatric clinical datasets. The fully sampled data ( n = 29 $$ n=29 $$ ) was retrospectively undersampled (6-11 × $$ \times $$ ) and reconstructed using CD-DL and a parallel imaging and compressed sensing method (PICS). Measurements of peak velocity and total flow were compared to determine the highest acceleration rate that provided accuracy and precision within ± 5 % $$ \pm 5\% $$ . Feasibility of CD-DL was demonstrated on prospectively undersampled datasets acquired in pediatric clinical patients ( n = 5 $$ n=5 $$ ) and compared to traditional parallel imaging (PI) and PICS. RESULTS The retrospective evaluation showed that 9 × $$ \times $$ accelerated 2D PC-MRI images reconstructed with CD-DL provided accuracy and precision (bias, [95 % $$ \% $$ confidence intervals]) within ± 5 % $$ \pm 5\% $$ . CD-DL showed higher accuracy and precision compared to PICS for measurements of peak velocity (2.8 % $$ \% $$ [ - 2 . 9 $$ -2.9 $$ , 4.5] vs. 3.9 % $$ \% $$ [ - 11 . 0 $$ -11.0 $$ , 4.9]) and total flow (1.8 % $$ \% $$ [ - 3 . 9 $$ -3.9 $$ , 3.4] vs. 2.9 % $$ \% $$ [ - 7 . 1 $$ -7.1 $$ , 6.9]). The prospective feasibility study showed that CD-DL provided higher accuracy and precision than PICS for measurements of peak velocity and total flow. CONCLUSION In a retrospective evaluation, CD-DL produced quantitative measurements of 2D PC-MRI peak velocity and total flow with ≤ 5 % $$ \le 5\% $$ error in both accuracy and precision for up to 9 × $$ \times $$ acceleration. Clinical feasibility was demonstrated using a prospective clinical deployment of our 8 × $$ \times $$ undersampled acquisition and CD-DL reconstruction in a cohort of pediatric patients.
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Affiliation(s)
- Julio A Oscanoa
- Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Ali B Syed
- Department of Radiology, Stanford University, Stanford, California, USA.,Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Christopher M Sandino
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | | | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, California, USA.,Cardiovascular Institute, Stanford University, Stanford, California, USA
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27
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Lee J, El Hangouche N, Pathrose A, Soulat G, Barker AJ, Thomas JD, Markl M. Bicuspid aortic valve morphology and hemodynamics by same-day echocardiography and cardiac MRI. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2047-2056. [PMID: 35294708 DOI: 10.1007/s10554-022-02593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
This study investigated the impact of bicuspid aortic valve (BAV) on valve morphology and motion as well as proximal and aortic hemodynamics using a same-day echocardiography and cardiac MRI. Transthoracic echocardiography, two-dimensional cine MRI of the aortic valve, and aortic 4D flow MRI were performed on the same day in 9 normofunctional BAV patients (age = 41 ± 12, 3 female), 4 BAV with moderate to severe aortic stenosis (AS) (age = 63 ± 5, 1 female), and 36 healthy tricuspid aortic valve controls (age = 52 ± 10, 21 female). Valve opening and closing timings and transvalvular peak velocity were measured using B-mode and Doppler echocardiogram, respectively. Valve orifice morphology at a fully-opened state was characterized using cine MRI. Ascending aortic (AAo) wall shear stress (WSS) was measured using 4D flow MRI data. Valve motion timings were similar between BAV and controls. BAV was associated with an increased orifice aspect ratio (1.44 ± 0.11 vs. 1.10 ± 0.13, P < 0.001), transvalvular peak velocity (1.5 ± 0.3 vs. 1.2 ± 0.2 m/s, P < 0.001) and maximum AAo WSS (1.62 ± 0.31 vs. 0.91 ± 0.24 Pa, P < 0.001). The increased orifice aspect ratio was associated with the increase in transvalvular peak velocity (r = 0.80, P < 0.0001) and maximum AAo WSS (r = 0.83, P < 0.0001). Transvalvular peak velocity was also positively correlated with maximum AAo WSS (r = 0.83, P < 0.0001). A same-day echo and MRI imaging allows for a comprehensive assessment of the impact of aortic valve disease on valve function and hemodynamics. In this pilot application to BAV, we found increased orifice aspect ratio may be responsible for increased transvalvular peak velocity and maximum AAo WSS.
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Affiliation(s)
- Jeesoo Lee
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA.
| | - Nadia El Hangouche
- Department of Cardiology, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - James D Thomas
- Department of Cardiology, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, 60208, USA
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Fischer C, Wetzl J, Schaeffter T, Giese D. Fully automated background phase correction using M-estimate SAmple consensus (MSAC)-Application to 2D and 4D flow. Magn Reson Med 2022; 88:2709-2717. [PMID: 35916368 DOI: 10.1002/mrm.29363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/11/2022] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Flow quantification by phase-contrast MRI is hampered by spatially varying background phase offsets. Correction performance by polynomial regression on stationary tissue may be affected by outliers such as wrap-around or constant flow. Therefore, we propose an alternative, M-estimate SAmple Consensus (MSAC) to reject outliers, and improve and fully automate background phase correction. METHODS The MSAC technique fits polynomials to randomly drawn small samples from the image. Over several trials, it aims to find the best consensus set of valid pixels by rejecting outliers to the fit and minimizing the residuals of the remaining pixels. The robustness of MSAC to its few parameters was investigated and verified using third-order polynomial correction fits on a total of 118 2D flow (97 with wrap-around) and 18 4D flow data sets (14 with wrap-around), acquired at 1.5 T and 3 T. Background phase was compared with standard stationary correction and phantom correction. Pulmonary/systemic flow ratios in 2D flow were derived, and exemplary 4D flow analysis was performed. RESULTS The MSAC technique is robust over a range of parameter choices, and a unique set of parameters is suitable for both 2D and 4D flow. In 2D flow, phase errors were significantly reduced by MSAC compared with stationary correction (p = 0.005), and stationary correction shows larger errors in pulmonary/systemic flow ratios compared with MSAC. In 4D flow, MSAC shows similar performance as stationary correction. CONCLUSIONS The MSAC method provides fully automated background phase correction to 2D and 4D flow data and shows improved robustness over stationary correction, especially with outliers present.
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Affiliation(s)
- Carola Fischer
- Department of Medical Imaging, Technical University of Berlin, Berlin, Germany.,Magnetic Resonance, Siemens Healthcare, Erlangen, Germany
| | - Jens Wetzl
- Magnetic Resonance, Siemens Healthcare, Erlangen, Germany
| | - Tobias Schaeffter
- Department of Medical Imaging, Technical University of Berlin, Berlin, Germany.,Biomedical Imaging, Physikalisch-Technische Bundesanstalt, Braunschweig and Berlin, Berlin, Germany.,School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare, Erlangen, Germany.,Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
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Chu S, Kilinc O, Pradella M, Weiss E, Baraboo J, Maroun A, Jarvis K, Mehta CK, Malaisrie SC, Hoel AW, Carr JC, Markl M, Allen BD. Baseline 4D Flow-Derived in vivo Hemodynamic Parameters Stratify Descending Aortic Dissection Patients With Enlarging Aortas. Front Cardiovasc Med 2022; 9:905718. [PMID: 35757320 PMCID: PMC9218246 DOI: 10.3389/fcvm.2022.905718] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of our study was to assess the value of true lumen and false lumen hemodynamics compared to aortic morphological measurements for predicting adverse-aorta related outcomes (AARO) and aortic growth in patients with type B aortic dissection (TBAD). Materials and Methods Using an IRB approved protocol, we retrospectively identified patients with descending aorta (DAo) dissection at a large tertiary center. Inclusion criteria includes known TBAD with ≥ 6 months of clinical follow-up after initial presentation for TBAD or after ascending aorta intervention for patients with repaired type A dissection with residual type B aortic dissection (rTAAD). Patients with prior descending aorta intervention were excluded. The FL and TL of each patient were manually segmented from 4D flow MRI data, and 3D parametric maps of aortic hemodynamics were generated. Groups were divided based on (1) presence vs. absence of AARO and (2) growth rate ≥ vs. < 3 mm/year. True and false lumen kinetic energy (KE), stasis, peak velocity (PV), reverse/forward flow (RF/FF), FL to TL KE ratio, as well as index aortic diameter were compared between groups using the Mann–Whitney U or independent t-test. Results A total of n = 51 patients (age: 58.4 ± 15.0 years, M/F: 31/20) were included for analysis of AARO. This group contained n = 26 patients with TBAD and n = 25 patients with rTAAD. In the overall cohort, AARO patients had larger baseline diameters, lower FL-RF, FL stasis, TL-KE, TL-FF and TL-PV. Among patients with de novo TBAD, those with AAROs had larger baseline diameter, lower FL stasis and TL-PV. In both the overall cohort and in the subgroup of de novo TBAD, subjects with aortic growth ≥ 3mm/year, patients had a higher KE ratio. Conclusion Our study suggests that 4D flow MRI is a promising tool for TBAD evaluation that can provide information beyond traditional MRA or CTA. 4D flow has the potential to become an integral aspect of TBAD work-up, as hemodynamic assessment may allow earlier identification of at-risk patients who could benefit from earlier intervention.
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Affiliation(s)
- Stanley Chu
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Ozden Kilinc
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Maurice Pradella
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Elizabeth Weiss
- Department of Radiology, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Justin Baraboo
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Anthony Maroun
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Christopher K Mehta
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, IL, United States
| | - S Chris Malaisrie
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, IL, United States
| | - Andrew W Hoel
- Department of Surgery (Vascular Surgery), Northwestern University, Chicago, IL, United States
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, IL, United States
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Aristova M, Pang J, Ma Y, Ma L, Berhane H, Rayz V, Markl M, Schnell S. Accelerated dual-venc 4D flow MRI with variable high-venc spatial resolution for neurovascular applications. Magn Reson Med 2022; 88:1643-1658. [PMID: 35754143 PMCID: PMC9392495 DOI: 10.1002/mrm.29306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/02/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022]
Abstract
Purpose Dual‐velocity encoded (dual‐venc or DV) 4D flow MRI achieves wide velocity dynamic range and velocity‐to‐noise ratio (VNR), enabling accurate neurovascular flow characterization. To reduce scan time, we present interleaved dual‐venc 4D Flow with independently prescribed, prospectively undersampled spatial resolution of the high‐venc (HV) acquisition: Variable Spatial Resolution Dual Venc (VSRDV). Methods A prototype VSRDV sequence was developed based on a Cartesian acquisition with eight‐point phase encoding, combining PEAK‐GRAPPA acceleration with zero‐filling in phase and partition directions for HV. The VSRDV approach was optimized by varying z, the zero‐filling fraction of HV relative to low‐venc, between 0%–80% in vitro (realistic neurovascular model with pulsatile flow) and in vivo (n = 10 volunteers). Antialiasing precision, mean and peak velocity quantification accuracy, and test–retest reproducibility were assessed relative to reference images with equal‐resolution HV and low venc (z = 0%). Results In vitro results for all z demonstrated an antialiasing true positive rate at least 95% for RPEAK−GRAPPA = 2 and 5, with no linear relationship to z (p = 0.62 and 0.13, respectively). Bland–Altman analysis for z = 20%, 40%, 60%, or 80% versus z = 0% in vitro and in vivo demonstrated no bias >1% of venc in mean or peak velocity values at any RZF. In vitro mean and peak velocity, and in vivo peak velocity, had limits of agreement within 15%. Conclusion VSRDV allows up to 34.8% scan time reduction compared to PEAK‐GRAPPA accelerated DV 4D Flow MRI, enabling large spatial coverage and dynamic range while maintaining VNR and velocity measurement accuracy. Click here for author‐reader discussions
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Affiliation(s)
- Maria Aristova
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jianing Pang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,MR R&D and Collaborations, Siemens Medical Solutions USA Inc., Chicago, IL, USA
| | - Yue Ma
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liliana Ma
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Evanston, Illinois, USA
| | - Vitaliy Rayz
- Weldon School of Biomedical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Evanston, Illinois, USA
| | - Susanne Schnell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institut für Physik, Universität Greifswald, Greifswald, Germany
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Roldán-Alzate A, Campo CA, Mao L, Said A, Wieben O, Reeder SB. Characterization of mesenteric and portal hemodynamics using 4D flow MRI: the effects of meals and diurnal variation. Abdom Radiol (NY) 2022; 47:2106-2114. [PMID: 35419747 PMCID: PMC10599799 DOI: 10.1007/s00261-022-03513-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the variability of blood flow measurements using 4D flow MRI in the portal and mesenteric circulations and to characterize the effects of meal ingestion, time of day, and between-day (diurnal) variations on portal and mesenteric hemodynamics. METHODS In this IRB-approved and HIPAA-compliant study, 7 healthy and 7 portal hypertension patients imaged. MRI exams were conducted at 3 T using a 32-channel body coil with large volumetric coverage and 1.25-mm isotropic true spatial resolution. Blood flow was quantified (L/min) in the hepatic and splanchnic vasculature. The first MR scan was performed after at least 8 h of fasting. Subsequently, subjects ingested 574 mL EnSure Plus® orally. A second acquisition was started 20 min after the meal ingestion. A third scan was performed before lunch and a fourth acquisition took place 20 min after lunch. A fifth scan was performed around 4 pm. Finally, subjects returned one week later for a repeat morning visit, with identical conditions as the first visit. RESULTS In healthy controls significant increase in blood flow was seen in the PV, SMV, SMA, HA, and SCAo in response to breakfast but only the SCAo, SMA, SMV, and PV had a significant response to lunch. In general, patients with cirrhosis showed reduced response to meals compared to that in healthy controls. Additionally, PV flow in patients had the highest value in the afternoon. CONCLUSION Effects of meal ingestion, time of day, and between-day variations were characterized using Radial 4D flow MRI in patients with cirrhosis and healthy controls.
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Affiliation(s)
- Alejandro Roldán-Alzate
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA.
- Department of Mechanical Engineering, University of Wisconsin, Madison, USA.
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA.
| | - Camilo A Campo
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, USA
| | - Adnan Said
- Department of Medicine, University of Wisconsin, Madison, USA
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
- Department of Medical Physics, University of Wisconsin, Madison, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
- Department of Medical Physics, University of Wisconsin, Madison, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, USA
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Non-invasive assessment of mesenteric hemodynamics in patients with suspected chronic mesenteric ischemia using 4D flow MRI. Abdom Radiol (NY) 2022; 47:1684-1698. [PMID: 33547918 DOI: 10.1007/s00261-020-02900-0] [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: 06/15/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Chronic mesenteric ischemia (CMI) is a rare disease with a particularly difficult diagnosis. In this study, 4D flow MRI is used to quantitatively evaluate mesenteric hemodynamics before and after a meal in patients suspected of having CMI and healthy individuals. METHODS Nineteen patients suspected of CMI and twenty control subjects were analyzed. Subjects were scanned using a radially undersampled 4D flow MR sequence (PC-VIPR). Flow rates were assessed in the supraceliac (SCAo) and infrarenal aorta, celiac artery, superior mesenteric artery (SMA), left and right renal arteries, superior mesenteric vein (SMV), splenic vein, and portal vein (PV) in a fasting state (preprandial) and 20 min after a 700-kcal meal (postprandial). Patients were subcategorized into positive diagnosis (CMI+, N = 6) and negative diagnosis (CMI-, N = 13) groups based on imaging and clinical findings. Preprandial, postprandial, and percent change in flow rates were compared between subgroups using a Welch t test. RESULTS In controls and CMI- patients, SCAo, SMA, SMV, and PV flow increased significantly after meal ingestion. No significant flow increases were observed in CMI+ patients. Percent changes in SMA, SMV, and PV flow were significantly greater in controls compared to CMI+ patients. Additionally, percent changes in flow in the SMV and PV were significantly greater in CMI- patients compared to CMI+ patients. CONCLUSIONS 4D flow MRI with large volumetric coverage demonstrated significant differences in the redistribution of blood flow in SMA, SMV, and PV in CMI+ patients after a meal challenge. This approach may assist in the challenging diagnosis of CMI.
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Arvidsson PM, Nelsson A, Magnusson M, Smith JG, Carlsson M, Arheden H. Hemodynamic force analysis is not ready for clinical trials on HFpEF. Sci Rep 2022; 12:4017. [PMID: 35256713 PMCID: PMC8901629 DOI: 10.1038/s41598-022-08023-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/22/2022] [Indexed: 01/11/2023] Open
Abstract
Hemodynamic force analysis has been proposed as a novel tool for early detection of subclinical systolic dysfunction in heart failure with preserved ejection fraction (HFpEF). Here we investigated the ability of hemodynamic forces to discriminate between healthy subjects and heart failure patients with varying degrees of systolic dysfunction. We studied 34 controls, 16 HFpEF patients, and 25 heart failure patients with mid-range (HFmrEF) or reduced ejection fraction (HFrEF) using cardiac magnetic resonance with acquisition of cine images and 4D flow at 1.5 T. The Navier-Stokes equation was used to compute global left ventricular hemodynamic forces over the entire cardiac cycle. Forces were analyzed for systole, diastole, and the entire heartbeat, with and without normalization to left ventricular volume. Volume-normalized hemodynamic forces demonstrated significant positive correlation with EF (r2 = 0.47, p < 0.0001) and were found significantly lower in heart failure with reduced ejection fraction compared to controls (p < 0.0001 for systole and diastole). No difference was seen between controls and HFpEF (p > 0.34). Non-normalized forces displayed no differences between controls and HFpEF (p > 0.24 for all analyses) and did not correlate with EF (p = 0.36). Left ventricular hemodynamic force analysis, whether indexed to LV volumes or not, is not ready for clinical trials on HFpEF assessment.
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Affiliation(s)
- Per M Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden
| | - Anders Nelsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden
| | - Martin Magnusson
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, 22185, Lund, Sweden.
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Roberts GS, Loecher MW, Spahic A, Johnson KM, Turski PA, Eisenmenger LB, Wieben O. Virtual injections using 4D flow MRI with displacement corrections and constrained probabilistic streamlines. Magn Reson Med 2021; 87:2495-2511. [PMID: 34971458 PMCID: PMC8884720 DOI: 10.1002/mrm.29134] [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: 07/15/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Streamlines from 4D-flow MRI have been used clinically for intracranial blood-flow tracking. However, deterministic and stochastic errors degrade streamline quality. The purpose of this study is to integrate displacement corrections, probabilistic streamlines, and novel fluid constraints to improve selective blood-flow tracking and emulate "virtual bolus injections." METHODS Both displacement artifacts (deterministic) and velocity noise (stochastic) inherently occur during phase-contrast MRI acquisitions. Here, two displacement correction methods, single-step and iterative, were tested in silico with simulated displacements and were compared with ground-truth velocity fields. Next, the effects of combining displacement corrections and constrained probabilistic streamlines were performed in 10 healthy volunteers using time-averaged 4D-flow data. Measures of streamline length and depth into vasculature were then compared with streamlines generated with no corrections and displacement correction alone using one-way repeated-measures analysis of variance and Friedman's tests. Finally, virtual injections with improved streamlines were generated for three intracranial pathology cases. RESULTS Iterative displacement correction outperformed the single-step method in silico. In volunteers, the combination of displacement corrections and constrained probabilistic streamlines allowed for significant improvements in streamline length and increased the number of streamlines entering the circle of Willis relative to streamlines with no corrections and displacement correction alone. In the pathology cases, virtual injections with improved streamlines were qualitatively similar to dynamic arterial spin labeling images and allowed for forward/reverse selective flow tracking to characterize cerebrovascular malformations. CONCLUSION Virtual injections with improved streamlines from 4D-flow MRI allow for flexible, robust, intracranial flow tracking.
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Affiliation(s)
- Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael W Loecher
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Alma Spahic
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Patrick A Turski
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Oliver Wieben
- 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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Yavuz Ilik S, Otani T, Yamada S, Watanabe Y, Wada S. A subject-specific assessment of measurement errors and their correction in cerebrospinal fluid velocity maps using 4D flow MRI. Magn Reson Med 2021; 87:2412-2423. [PMID: 34866235 DOI: 10.1002/mrm.29111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Phase-contrast MRI (PC-MRI) of cerebrospinal fluid (CSF) velocity is used to evaluate the characteristics of intracranial diseases, such as normal-pressure hydrocephalus (NPH). Nevertheless, PC-MRI has several potential error sources, with eddy-current-based phase offset error being non-negligible in CSF measurement. In this study, we assess the measurement error of CSF velocity maps obtained using 4D flow MRI and evaluate correction methods. METHODS CSF velocity maps of 10 patients with NPH were acquired using 4D flow MRI (velocity-encoding = 5 cm/s). Distributed phase offset error was estimated for a whole 3D background field by polynomial fitting using robust regression analysis. This estimated phase offset error was then used to correct the CSF velocity maps. The estimated error profiles were compared with those obtained using an existing 2D correction approach involving local background information near the region of interest. RESULTS The residual standard error of the polynomial fitting against the phase offset error extracted from the measured velocities was within 0.2 cm/s. The spatial dependencies of the phase offset errors showed similar tendencies in all cases, but sufficient differences in these values were found to indicate requirement of velocity correction. Differences of the estimated errors among other correction approaches were in the order of 10-2 cm/s, and the estimated errors were in good agreement with those obtained using existing approaches. CONCLUSION Our method is capable of estimating the measurement error of CSF velocity maps obtained from 4D flow MRI and provides quantitatively reasonable characteristics for the main CSF profile in the cerebral aqueduct in patients with NPH.
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Affiliation(s)
- Selin Yavuz Ilik
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Tomohiro Otani
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shigeo Wada
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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Marlevi D, Schollenberger J, Aristova M, Ferdian E, Ma Y, Young AA, Edelman ER, Schnell S, Figueroa CA, Nordsletten DA. Noninvasive quantification of cerebrovascular pressure changes using 4D Flow MRI. Magn Reson Med 2021; 86:3096-3110. [PMID: 34431550 DOI: 10.1002/mrm.28928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Hemodynamic alterations are indicative of cerebrovascular disease. However, the narrow and tortuous cerebrovasculature complicates image-based assessment, especially when quantifying relative pressure. Here, we present a systematic evaluation of image-based cerebrovascular relative pressure mapping, investigating the accuracy of the routinely used reduced Bernoulli (RB), the extended unsteady Bernoulli (UB), and the full-field virtual work-energy relative pressure ( ν WERP) method. METHODS Patient-specific in silico models were used to generate synthetic cerebrovascular 4D Flow MRI, with RB, UB, and ν WERP performance quantified as a function of spatiotemporal sampling and image noise. Cerebrovascular relative pressures were also derived in 4D Flow MRI from healthy volunteers ( n = 8 ), acquired at two spatial resolutions (dx = 1.1 and 0.8 mm). RESULTS The in silico analysis indicate that accurate relative pressure estimations are inherently coupled to spatial sampling: at dx = 1.0 mm high errors are reported for all methods; at dx = 0.5 mm ν WERP recovers relative pressures at a mean error of 0.02 ± 0.25 mm Hg, while errors remain higher for RB and UB (mean error of -2.18 ± 1.91 and -2.18 ± 1.87 mm Hg, respectively). The dependence on spatial sampling is also indicated in vivo, albeit with higher correlative dependence between resolutions using ν WERP (k = 0.64, R2 = 0.81 for dx = 1.1 vs. 0.8 mm) than with RB or UB (k = 0.04, R2 = 0.03, and k = 0.07, R2 = 0.07, respectively). CONCLUSION Image-based full-field methods such as ν WERP enable cerebrovascular relative pressure mapping; however, accuracy is directly dependent on utilized spatial resolution.
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Affiliation(s)
- David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jonas Schollenberger
- Department of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Maria Aristova
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Edward Ferdian
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Yue Ma
- Department of Radiology, Northwestern University, Chicago, IL, USA
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, UK
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Susanne Schnell
- Department of Radiology, Northwestern University, Chicago, IL, USA
- Department of Medical Physics, Institute of Physics, University of Greifswald, Greifswald, Germany
| | - C Alberto Figueroa
- Department of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - David A Nordsletten
- Department of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, UK
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Shen D, Pathrose A, Sarnari R, Blake A, Berhane H, Baraboo JJ, Carr JC, Markl M, Kim D. Automated segmentation of biventricular contours in tissue phase mapping using deep learning. NMR IN BIOMEDICINE 2021; 34:e4606. [PMID: 34476863 PMCID: PMC8795858 DOI: 10.1002/nbm.4606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
Tissue phase mapping (TPM) is an MRI technique for quantification of regional biventricular myocardial velocities. Despite its potential, clinical use is limited due to the requisite labor-intensive manual segmentation of cardiac contours for all time frames. The purpose of this study was to develop a deep learning (DL) network for automated segmentation of TPM images, without significant loss in segmentation and myocardial velocity quantification accuracy compared with manual segmentation. We implemented a multi-channel 3D (three dimensional; 2D + time) dense U-Net that trained on magnitude and phase images and combined cross-entropy, Dice, and Hausdorff distance loss terms to improve the segmentation accuracy and suppress unnatural boundaries. The dense U-Net was trained and tested with 150 multi-slice, multi-phase TPM scans (114 scans for training, 36 for testing) from 99 heart transplant patients (44 females, 1-4 scans/patient), where the magnitude and velocity-encoded (Vx , Vy , Vz ) images were used as input and the corresponding manual segmentation masks were used as reference. The accuracy of DL segmentation was evaluated using quantitative metrics (Dice scores, Hausdorff distance) and linear regression and Bland-Altman analyses on the resulting peak radial and longitudinal velocities (Vr and Vz ). The mean segmentation time was about 2 h per patient for manual and 1.9 ± 0.3 s for DL. Our network produced good accuracy (median Dice = 0.85 for left ventricle (LV), 0.64 for right ventricle (RV), Hausdorff distance = 3.17 pixels) compared with manual segmentation. Peak Vr and Vz measured from manual and DL segmentations were strongly correlated (R ≥ 0.88) and in good agreement with manual analysis (mean difference and limits of agreement for Vz and Vr were -0.05 ± 0.98 cm/s and -0.06 ± 1.18 cm/s for LV, and -0.21 ± 2.33 cm/s and 0.46 ± 4.00 cm/s for RV, respectively). The proposed multi-channel 3D dense U-Net was capable of reducing the segmentation time by 3,600-fold, without significant loss in accuracy in tissue velocity measurements.
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Affiliation(s)
- Daming Shen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Allison Blake
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
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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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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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Kim D, Eisenmenger L, Turski P, Johnson KM. Simultaneous 3D-TOF angiography and 4D-flow MRI with enhanced flow signal using multiple overlapping thin slab acquisition and magnetization transfer. Magn Reson Med 2021; 87:1401-1417. [PMID: 34708445 DOI: 10.1002/mrm.29060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the fusion of 3D time-of-flight principles into 4D-flow MRI to enhance vessel contrast and signal without an exogenous contrast agent, enabling simultaneous in-flow based angiograms. METHODS A 4D-flow MRI technique was developed consisting of multiple overlapping slabs with intermittent magnetization transfer preparation. The scan time penalty associated with multiple slab acquisitions was mitigated by using undersampled distributed spiral trajectories and compressed sensing reconstruction. A flow phantom was used to characterize in-flow enhancement, velocity noise improvement, and flow rate measurements against the single-slab 4D-flow MRI. In a patient-volunteer cohort (n = 15), magnitude-based angiograms were radiologically evaluated against 3D time-of-flight, and velocity measurements were compared pixel-wise against single-slab and contrast-enhanced 4D-flow MRI. RESULTS Multiple-slab acquisitions, together with magnetization transfer preparation, substantially improved vessel signal, contrast, and vessel conspicuity in magnitude angiograms. Both clinical 3D time-of-flight and the proposed technique produced equivalent vessel depictions with no statistically significant difference (p < .1). Both techniques also produced clear depictions of brain aneurysms in all patients; however, very small vessels tended to show reduced conspicuity in the proposed technique. Velocity measurements agreed with contrast-enhanced and single-slab scans with high correlations (R2 = 0.941-0.974) and agreements (slopes = 0.994-1.071). Slab boundary and magnetization transfer-related artifacts were not observed in velocity measurements, and velocity noise was reduced with in-flow enhancement over single-slab scans (phantom). CONCLUSION The vessel signal and contrast can be improved in 4D-flow MRI without exogenous contrast agents by utilizing in-flow enhancement, efficient sampling, and compressed sensing. The in-flow enhancement also enables simultaneous 3D time-of-flight angiograms useful for flow quantification and diagnosis.
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Affiliation(s)
- Dahan Kim
- Department of Physics, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Patrick Turski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Macdonald JA, Roberts GS, Corrado PA, Beshish AG, Haraldsdottir K, Barton GP, Goss KN, Eldridge MW, Francois CJ, Wieben O. Exercise-induced irregular right heart flow dynamics in adolescents and young adults born preterm. J Cardiovasc Magn Reson 2021; 23:116. [PMID: 34670573 PMCID: PMC8529801 DOI: 10.1186/s12968-021-00816-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/24/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Preterm birth has been linked to an elevated risk of heart failure and cardiopulmonary disease later in life. With improved neonatal care and survival, most infants born preterm are now reaching adulthood. In this study, we used 4D flow cardiovascular magnetic resonance (CMR) coupled with an exercise challenge to assess the impact of preterm birth on right heart flow dynamics in otherwise healthy adolescents and young adults who were born preterm. METHODS Eleven young adults and 17 adolescents born preterm (< 32 weeks of gestation and < 1500 g birth weight) were compared to 11 young adult and 18 adolescent age-matched controls born at term. Stroke volume, cardiac output, and flow in the main pulmonary artery were quantified with 4D flow CMR. Kinetic energy and vorticity were measured in the right ventricle. All parameters were measured at rest and during exercise at a power corresponding to 70% VO2max for each subject. Multivariate linear regression was used to perform age-adjusted term-preterm comparisons. RESULTS With exercise, stroke volume increased 10 ± 21% in term controls and decreased 4 ± 18% in preterm born subjects (p = 0.007). This resulted in significantly reduced capacity to increase cardiac output in response to exercise stress for the preterm group (58 ± 26% increase in controls, 36 ± 27% increase in preterm, p = 0.004). Elevated kinetic energy (KEterm = 71 ± 22 nJ, KEpreterm = 87 ± 38 nJ, p = 0.03) and vorticity (ωterm = 79 ± 16 s-1, ωpreterm = 94 ± 32 s-1, p = 0.01) during diastole in the right ventricle (RV) suggested altered RV flow dynamics in the preterm subjects. Streamline visualizations showed altered structure to the diastolic filling vortices in those born preterm. CONCLUSIONS For the participants examined here, preterm birth appeared to result in altered right-heart flow dynamics as early as adolescence, especially during diastole. Future studies should evaluate whether the altered dynamics identified here evolves into cardiopulmonary disease later in life. Trial registration None.
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Affiliation(s)
| | - Grant S Roberts
- Medical Physics, University of Wisconsin-Madison, Madison, USA
| | | | - Arij G Beshish
- Pediatrics, University of Wisconsin-Madison, Madison, USA
| | | | | | - Kara N Goss
- Pediatrics, University of Wisconsin-Madison, Madison, USA
- Medicine, University of Wisconsin-Madison, Madison, USA
| | - Marlowe W Eldridge
- Pediatrics, University of Wisconsin-Madison, Madison, USA
- Biomedical Engineering, University of Wisconsin-Madison, Madison, USA
| | | | - Oliver Wieben
- Medical Physics, University of Wisconsin-Madison, Madison, USA
- Biomedical Engineering, University of Wisconsin-Madison, Madison, USA
- Radiology, University of Wisconsin-Madison, Madison, USA
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Lagerstrand KM, Truedsson F, Gao SA, Johansson A, Bech-Hanssen O, Polte CL, Johnsson ÅA. Importance of through-plane heart motion correction for the assessment of aortic regurgitation severity using phase contrast magnetic resonance imaging. Magn Reson Imaging 2021; 84:69-75. [PMID: 34560232 DOI: 10.1016/j.mri.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To elucidate the influence of through-plane heart motion on the assessment of aortic regurgitation (AR) severity using phase contrast magnetic resonance imaging (PC-MRI). APPROACH A patient cohort with chronic AR (n = 34) was examined with PC-MRI. The regurgitant volume (RVol) and fraction (RFrac) were extracted from the PC-MRI data before and after through-plane heart motion correction and was then used for assessment of AR severity. RESULTS The flow volume errors were strongly correlated to aortic diameter (R = 0.80, p < 0.001) with median (IQR 25%;75%): 16 (14; 17) ml for diameter>40mm, compared with 9 (7; 10) ml for normal aortic size (p < 0.001). RVol and RFrac were underestimated (uncorrected:64 ± 37 ml and 39 ± 17%; corrected:76 ± 37 ml and 44 ± 15%; p < 0.001) and ~ 20% of the patients received lower severity grade without correction. CONCLUSION Through-plane heart motion introduces relevant flow volume errors, especially in patients with aortic dilatation that may result in underestimation of the severity grade in patients with chronic AR.
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Affiliation(s)
- Kerstin M Lagerstrand
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Frida Truedsson
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sinsia A Gao
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexander Johansson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian L Polte
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Sweden
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Chen X, Jiang Y, Choi S, Pohmann R, Scheffler K, Kleinfeld D, Yu X. Assessment of single-vessel cerebral blood velocity by phase contrast fMRI. PLoS Biol 2021; 19:e3000923. [PMID: 34499636 PMCID: PMC8454982 DOI: 10.1371/journal.pbio.3000923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/21/2021] [Accepted: 07/28/2021] [Indexed: 12/30/2022] Open
Abstract
Current approaches to high-field functional MRI (fMRI) provide 2 means to map hemodynamics at the level of single vessels in the brain. One is through changes in deoxyhemoglobin in venules, i.e., blood oxygenation level-dependent (BOLD) fMRI, while the second is through changes in arteriole diameter, i.e., cerebral blood volume (CBV) fMRI. Here, we introduce cerebral blood flow-related velocity-based fMRI, denoted CBFv-fMRI, which uses high-resolution phase contrast (PC) MRI to form velocity measurements of flow. We use CBFv-fMRI in measure changes in blood velocity in single penetrating microvessels across rat parietal cortex. In contrast to the venule-dominated BOLD and arteriole-dominated CBV fMRI signals, CBFv-fMRI is comparable from both arterioles and venules. A single fMRI platform is used to map changes in blood pO2 (BOLD), volume (CBV), and velocity (CBFv). This combined high-resolution single-vessel fMRI mapping scheme enables vessel-specific hemodynamic mapping in animal models of normal and diseased states and further has translational potential to map vascular dementia in diseased or injured human brains with ultra-high-field fMRI.
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Affiliation(s)
- Xuming Chen
- High-Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Neurology, Wuhan University, Renmin Hospital, Wuhan, China
| | - Yuanyuan Jiang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Sangcheon Choi
- High-Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany
| | - Rolf Pohmann
- High-Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Klaus Scheffler
- High-Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - David Kleinfeld
- Department of Physics, University of California at San Diego, La Jolla, California, United States of America
- Section of Neurobiology, University of California at San Diego, La Jolla, California, United States of America
| | - Xin Yu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, United States of America
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Demir A, Wiesemann S, Erley J, Schmitter S, Trauzeddel RF, Pieske B, Hansmann J, Kelle S, Schulz-Menger J. Traveling Volunteers: A Multi-Vendor, Multi-Center Study on Reproducibility and Comparability of 4D Flow Derived Aortic Hemodynamics in Cardiovascular Magnetic Resonance. J Magn Reson Imaging 2021; 55:211-222. [PMID: 34173297 DOI: 10.1002/jmri.27804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Implementation of four-dimensional flow magnetic resonance (4D Flow MR) in clinical routine requires awareness of confounders. PURPOSE To investigate inter-vendor comparability of 4D Flow MR derived aortic hemodynamic parameters, assess scan-rescan repeatability, and intra- and interobserver reproducibility. STUDY TYPE Prospective multicenter study. POPULATION Fifteen healthy volunteers (age 24.5 ± 5.3 years, 8 females). FIELD STRENGTH/SEQUENCE 3 T, vendor-provided and clinically used 4D Flow MR sequences of each site. ASSESSMENT Forward flow volume, peak velocity, average, and maximum wall shear stress (WSS) were assessed via nine planes (P1-P9) throughout the thoracic aorta by a single observer (AD, 2 years of experience). Inter-vendor comparability as well as scan-rescan, intra- and interobserver reproducibility were examined. STATISTICAL TESTS Equivalence was tested setting the 95% confidence interval of intraobserver and scan-rescan difference as the limit of clinical acceptable disagreement. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used for scan-rescan reproducibility and intra- and interobserver agreement. A P-value <0.05 was considered statistically significant. ICCs ≥ 0.75 indicated strong correlation (>0.9: excellent, 0.75-0.9: good). RESULTS Ten volunteers finished the complete study successfully. 4D flow derived hemodynamic parameters between scanners of three different vendors are not equivalent exceeding the equivalence range. P3-P9 differed significantly between all three scanners for forward flow (59.1 ± 13.1 mL vs. 68.1 ± 12.0 mL vs. 55.4 ± 13.1 mL), maximum WSS (1842.0 ± 190.5 mPa vs. 1969.5 ± 398.7 mPa vs. 1500.6 ± 247.2 mPa), average WSS (1400.0 ± 149.3 mPa vs. 1322.6 ± 211.8 mPa vs. 1142.0 ± 198.5 mPa), and peak velocity between scanners I vs. III (114.7 ± 12.6 cm/s vs. 101.3 ± 15.6 cm/s). Overall, the plane location at the sinotubular junction (P1) presented most inter-vendor stability (forward: 78.5 ± 15.1 mL vs. 80.3 ± 15.4 mL vs. 79.5 ± 19.9 mL [P = 0.368]; peak: 126.4 ± 16.7 cm/s vs. 119.7 ± 13.6 cm/s vs. 111.2 ± 22.6 cm/s [P = 0.097]). Scan-rescan reproducibility and intra- and interobserver variability were good to excellent (ICC ≥ 0.8) with best agreement for forward flow (ICC ≥ 0.98). DATA CONCLUSION The clinical protocol used at three different sites led to differences in hemodynamic parameters assessed by 4D flow. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Aylin Demir
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Stephanie Wiesemann
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Ralf Felix Trauzeddel
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Burkert Pieske
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany
| | - Jochen Hansmann
- Department of Radiology, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany
| | - Sebastian Kelle
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Abstract
MRI is an essential diagnostic tool in the anatomic and functional evaluation of cardiovascular disease. In many practices, 2D phase-contrast (2D-PC) has been used for blood flow quantification. 4D Flow MRI is a time-resolved volumetric acquisition that captures the vector field of blood flow along with anatomic images. 4D Flow MRI provides a simpler acquisition compared to 2D-PC and facilitates a more accurate and comprehensive hemodynamic assessment. Advancements in accelerated imaging have significantly shortened scan times of 4D Flow MRI while preserving image quality, enabling this technology to transition from the research arena to routine clinical practice. In this article, we review technical optimization based on our clinical experience of over 10 years with 4D Flow MRI. We also present pearls and pitfalls in the practical application of 4D Flow MRI, including how to quantify cardiovascular shunts, valvular or vascular stenosis, and valvular regurgitation. As experience increases, and as 4D Flow sequences and post-processing software become more broadly available, 4D Flow MRI will likely become an essential component of cardiac imaging for practices involved in the management of congenital and acquired structural heart disease.
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46
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Cortical thinning is associated with brain pulsatility in older adults: An MRI and NIRS study. Neurobiol Aging 2021; 106:103-118. [PMID: 34274697 DOI: 10.1016/j.neurobiolaging.2021.05.002] [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: 03/24/2020] [Revised: 03/29/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
Aging is accompanied by global brain atrophy occurring unequally across the brain. Cortical thinning is seen with aging with a larger loss in the frontal and temporal subregions. We explored the link between regional cortical thickness and regional cerebral pulsatility. Sixty healthy individuals were divided into two age groups, young (aged 19-31) and older (aged 65-75) adults. Each participant underwent a near-infrared spectroscopy (NIRS) scan to index regional brain pulsatility from cerebral pulse-transit-time-to-the peak-of-the-pulse (PTTp), an anatomical magnetic resonance imaging (MRI) and a phase-contrast MRI (PC-MRI) scan to measure arterial and cerebrospinal fluid (CSF) pulsatility. In older adults, the greatest association between cerebral pulsatility and cortical thickness was found in superior and middle temporal and superior, middle and inferior frontal areas, which are the regions perfused first by the internal carotid arteries. This association dropped in the postcentral and superior parietal regions. These findings suggest higher brain pulsatility as a potential risk factor contributing to cortical thinning for some brain regions more than others.
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47
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Williams G, Thyagaraj S, Fu A, Oshinski J, Giese D, Bunck AC, Fornari E, Santini F, Luciano M, Loth F, Martin BA. In vitro evaluation of cerebrospinal fluid velocity measurement in type I Chiari malformation: repeatability, reproducibility, and agreement using 2D phase contrast and 4D flow MRI. Fluids Barriers CNS 2021; 18:12. [PMID: 33736664 PMCID: PMC7977612 DOI: 10.1186/s12987-021-00246-3] [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] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/03/2021] [Indexed: 11/11/2022] Open
Abstract
Background Phase contrast magnetic resonance imaging, PC MRI, is a valuable tool allowing for non-invasive quantification of CSF dynamics, but has lacked adoption in clinical practice for Chiari malformation diagnostics. To improve these diagnostic practices, a better understanding of PC MRI based measurement agreement, repeatability, and reproducibility of CSF dynamics is needed. Methods An anatomically realistic in vitro subject specific model of a Chiari malformation patient was scanned three times at five different scanning centers using 2D PC MRI and 4D Flow techniques to quantify intra-scanner repeatability, inter-scanner reproducibility, and agreement between imaging modalities. Peak systolic CSF velocities were measured at nine axial planes using 2D PC MRI, which were then compared to 4D Flow peak systolic velocity measurements extracted at those exact axial positions along the model. Results Comparison of measurement results showed good overall agreement of CSF velocity detection between 2D PC MRI and 4D Flow (p = 0.86), fair intra-scanner repeatability (confidence intervals ± 1.5 cm/s), and poor inter-scanner reproducibility. On average, 4D Flow measurements had a larger variability than 2D PC MRI measurements (standard deviations 1.83 and 1.04 cm/s, respectively). Conclusion Agreement, repeatability, and reproducibility of 2D PC MRI and 4D Flow detection of peak CSF velocities was quantified using a patient-specific in vitro model of Chiari malformation. In combination, the greatest factor leading to measurement inconsistency was determined to be a lack of reproducibility between different MRI centers. Overall, these findings may help lead to better understanding for application of 2D PC MRI and 4D Flow techniques as diagnostic tools for CSF dynamics quantification in Chiari malformation and related diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00246-3.
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Affiliation(s)
- Gwendolyn Williams
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844, USA
| | - Suraj Thyagaraj
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, 44325, USA
| | - Audrey Fu
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, ID, 83844, USA
| | - John Oshinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
| | - Daniel Giese
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Eleonora Fornari
- CIBM, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Francesco Santini
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Mark Luciano
- Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA
| | - Francis Loth
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, 44325, USA
| | - Bryn A Martin
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844, USA. .,Alcyone Therapeutics Inc, Lowell, MA, USA.
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Wymer DT, Patel KP, Burke WF, Bhatia VK. Phase-Contrast MRI: Physics, Techniques, and Clinical Applications. Radiographics 2021; 40:122-140. [PMID: 31917664 DOI: 10.1148/rg.2020190039] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
With phase-contrast imaging, the MRI signal is used to visualize and quantify velocity. This imaging modality relies on phase data, which are intrinsic to all MRI signals. With use of bipolar gradients, degrees of phase shift are encoded and in turn correlated directly with the velocity of protons. The acquisition of diagnostic-quality images requires selection of the correct imaging plane to ensure accurate measurement and selection of the encoding velocity and thus prevent aliasing and achieve the highest signal-to-noise ratio. Multiple applications of phase-contrast imaging are actively used in clinical practice. One of the most common clinical uses is in cardiac valvular flow imaging, at which the data are used to assess the severity of valvular disease and quantify the shunt fraction. In neurologic imaging, phase-contrast imaging can be used to measure the flow of cerebrospinal fluid. This measurement can aid in the diagnosis and direct management of normal pressure hydrocephalus or be used to evaluate the severity of stenosis, such as that in Chiari I malformations. At vascular analysis, phase-contrast imaging can be used to visualize arterial and venous flow, and this application is used most commonly in the brain. Three-dimensional imaging can yield highly detailed flow data in a technique referred to as four-dimensional flow. A more recently identified application is in MR elastography. Shear waves created by using an impulse device can be velocity encoded, and this velocity is directly proportional to the stiffness of the organ, or the shear modulus. This imaging modality is most commonly used in the liver for evaluation of cirrhosis and steatosis, although research on the assessment of other organs is being performed. Phase-contrast imaging is an important tool in the arsenal of MRI examinations and has many applications. Proper use of phase-contrast imaging requires an understanding of the many practical and technical factors and unique physics principles underlying the technique.©RSNA, 2020.
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Affiliation(s)
- David T Wymer
- From the Department of Diagnostic Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Kunal P Patel
- From the Department of Diagnostic Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - William F Burke
- From the Department of Diagnostic Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Vinay K Bhatia
- From the Department of Diagnostic Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
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49
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4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction. Int J Cardiovasc Imaging 2021; 37:2755-2765. [PMID: 33523363 DOI: 10.1007/s10554-021-02167-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆PMRI) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KELA) was computed throughout systole. Average systolic (KELA-avg) and peak systolic (KELA-peak) KELA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆PMRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KELA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KELA-avg (14.8 [10.6, 20.4] J/m3 vs. 33.4 [23.9, 61.3] J/m3, P < 0.001) and KELA-peak (22.1 [15.9, 28.7] J/m3 vs. 57.2 [44.5, 121.4] J/m3, P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KELA-avg (rho = 0.81, P < 0.001) and KELA-peak (rho = 0.79, P < 0.001). LVOT ∆PMRI was strongly correlated with KELA metrics in obstructive HCM (KELA-avg: rho = 0.86, P < 0.001; KELA-peak: rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction.
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50
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Kroeger JR, Pavesio FC, Mörsdorf R, Weiss K, Bunck AC, Baeßler B, Maintz D, Giese D. Velocity quantification in 44 healthy volunteers using accelerated multi-VENC 4D flow CMR. Eur J Radiol 2021; 137:109570. [PMID: 33596498 DOI: 10.1016/j.ejrad.2021.109570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the feasibility of a k-t accelerated multi-VENC 4D phase contrast flow MRI acquisition of the main heart-surrounding vessels, its benefits over a traditional single-VENC acquisition and to present reference flow and velocity values in a large cohort of volunteers. METHODS 44 healthy volunteers were examined on a 3 T MRI scanner (Ingenia, Philips, Best, The Netherlands). 4D flow measurements were obtained with a FOV including the aorta and the pulmonary arteries. VENC values were set to 40, 100 and 200 cm/s and unfolded based on an MRI signal model. Unfolded multi-VENC data was compared to the single-VENC with VENC 200 cm/s. Flow and velocity quantification was performed in several regions of interest (ROI) placed in the ascending aorta and in the main pulmonary artery. Conservation of mass analysis was performed for single- and multi-VENC datasets. Values for mean and maximal flow velocity and stroke volume were calculated and compared to the literature. RESULTS Mean scan time was 13.8 ± 4 min. Differences between stroke volumes between the ascending aorta and the main pulmonary artery were significantly lower in multi-VENC datasets compared to single-VENC datasets (9.6 ± 7.8 mL vs. 25.4 ± 26.4 mL, p < 0.001). This was also true for differences in stroke volume between up- and downstream ROIs in the ascending aorta and pulmonary artery. Values for mean and maximal velocities and stroke volume were in-line with previous studies. To highlight potential clinical applications two exemplary 4D flow measurements in patients with different pathologies are shown and compared to single-VENC datasets. CONCLUSIONS k-t accelerated multi-VENC 4D phase contrast flow MRI acquisition of the great vessels is feasible in a clinically acceptable scan duration. It offers improvements over traditional single-VENC 4D flow, expectedly being valuable when vessels with different flow velocities or complex flow phenomena are evaluated.
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Affiliation(s)
- Jan Robert Kroeger
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany.
| | - Francesca Claudia Pavesio
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Richard Mörsdorf
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Kilian Weiss
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Philips GmbH, Hamburg, Germany.
| | - Alexander Christian Bunck
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Bettina Baeßler
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - David Maintz
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Daniel Giese
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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