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Leo I, Sabatino J, Avesani M, Moscatelli S, Bianco F, Borrelli N, De Sarro R, Leonardi B, Calcaterra G, Surkova E, Di Salvo G. Non-Invasive Imaging Assessment in Patients with Aortic Coarctation: A Contemporary Review. J Clin Med 2023; 13:28. [PMID: 38202035 PMCID: PMC10779918 DOI: 10.3390/jcm13010028] [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: 10/07/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Coarctation of the aorta (CoA) is a congenital abnormality characterized by a narrowing of the aortic lumen, which can lead to significant morbidity and mortality if left untreated. Even after repair and despite significant advances in therapeutic management, these patients have overall reduced long-term survival due to the consequences of chronic afterload increase. Cardiovascular imaging is key from the first diagnosis to serial follow-up. In recent years, novel imaging techniques have emerged, increasing accessibility to advanced imaging modalities and enabling early and non-invasive identification of complications after repair. The aim of this paper is to provide a comprehensive review of the role of different imaging techniques in the evaluation and management of patients with native or repaired CoA, highlighting their unique strengths and limitations.
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Affiliation(s)
- Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (I.L.)
- CMR Unit, Royal Brompton and Harefield Hospitals, London SW3 5NP, UK;
| | - Jolanda Sabatino
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (I.L.)
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
| | - Sara Moscatelli
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital, London WC1N 3JH, UK;
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
| | - Francesco Bianco
- Cardiovascular Sciences Department, AOU “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | - Rosalba De Sarro
- Department of Experimental and Clinical Medicine, University of Messina, 98166 Messina, Italy;
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | | | - Elena Surkova
- CMR Unit, Royal Brompton and Harefield Hospitals, London SW3 5NP, UK;
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy;
- Paediatric Research Institute (IRP), Città Della Speranza, 35127 Padua, Italy
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Shibagaki Y, Oka H, Nakau K, Takahashi S. Intraventricular haemodynamic changes caused by increased left ventricular afterload in re-coarctation of aorta: a case report. Eur Heart J Case Rep 2023; 7:ytad514. [PMID: 37942351 PMCID: PMC10629689 DOI: 10.1093/ehjcr/ytad514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/14/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
Background Long-term re-coarctation of the aorta can cause aortic dilatation, hypertension, and cardiac dysfunction due to increased left ventricular (LV) afterload. It is difficult to detect changes in LV function due to increased afterload if the contractile force of the left ventricle is maintained. Herein, we have reported a case of re-coarctation of the aorta, for which four-dimensional (4D) flow magnetic resonance imaging (MRI) scan was obtained both before and after balloon dilatation for aortic re-coarctation. Ultimately, improvement in aortic helical flow and LV haemodynamics was observed. Case summary A 29-year-old female was diagnosed with coarctation of the aorta and a bicuspid aortic valve after birth and underwent surgery at 1 month. At 8 years of age, she underwent balloon dilatation for re-coarctation. At the age of 28 years, she was diagnosed with re-coarctation triggered by hypertension. She underwent balloon dilatation as her cardiac catheterization revealed a systolic pressure gradient of 40 mmHg. Pretreatment 4D flow MRI demonstrated helical flow in the ascending aorta and descending thoracic aorta and LV blood flow analysis revealed a decrease in LV kinetic energy during systole; these improved after treatment. Discussion The use of helical flow evaluation by 4D flow MRI for aortic re-coarctation is well known in clinical practice. However, our report is the first to evaluate intraventricular blood flow before and after the re-coarctation treatment. The MRI evaluation demonstrated that the helical flow and LV blood flow distribution improved after re-coarctation treatment due to the reduction of afterload.
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Affiliation(s)
- Yuki Shibagaki
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan
| | - Hideharu Oka
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan
| | - Kouichi Nakau
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido 078-8510, Japan
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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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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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Osztrogonacz P, Berczeli M, Chinnadurai P, Chang SM, Shah DJ, Lumsden AB. Dynamic Imaging of Aortic Pathologies: Review of Clinical Applications and Imaging Protocols. Methodist Debakey Cardiovasc J 2023; 19:4-14. [PMID: 36910554 PMCID: PMC10000327 DOI: 10.14797/mdcvj.1172] [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: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 03/09/2023] Open
Abstract
The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging modalities to evaluate different aortic pathologies. While vascular ultrasound and aortography are considered to be the bread and butter imaging modalities, newer dynamic imaging techniques provide time-resolved information in various aortic pathologies. However, despite growing evidence of their advantages in the literature, they have not been routinely adopted. In order to understand the role of these emerging modalities, one must understand their principles, advantages, and limitations in the context of various clinical scenarios. In this review, we provide an overview of dynamic imaging techniques for aortic pathologies and describe various dynamic computed tomography and magnetic resonance imaging protocols, clinical applications, and potential future directions.
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Affiliation(s)
- Peter Osztrogonacz
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Marton Berczeli
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Ponraj Chinnadurai
- Houston Methodist Hospital, Houston, Texas, US.,Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, US
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Peper ES, van Ooij P, Jung B, Huber A, Gräni C, Bastiaansen JAM. Advances in machine learning applications for cardiovascular 4D flow MRI. Front Cardiovasc Med 2022; 9:1052068. [PMID: 36568555 PMCID: PMC9780299 DOI: 10.3389/fcvm.2022.1052068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Four-dimensional flow magnetic resonance imaging (MRI) has evolved as a non-invasive imaging technique to visualize and quantify blood flow in the heart and vessels. Hemodynamic parameters derived from 4D flow MRI, such as net flow and peak velocities, but also kinetic energy, turbulent kinetic energy, viscous energy loss, and wall shear stress have shown to be of diagnostic relevance for cardiovascular diseases. 4D flow MRI, however, has several limitations. Its long acquisition times and its limited spatio-temporal resolutions lead to inaccuracies in velocity measurements in small and low-flow vessels and near the vessel wall. Additionally, 4D flow MRI requires long post-processing times, since inaccuracies due to the measurement process need to be corrected for and parameter quantification requires 2D and 3D contour drawing. Several machine learning (ML) techniques have been proposed to overcome these limitations. Existing scan acceleration methods have been extended using ML for image reconstruction and ML based super-resolution methods have been used to assimilate high-resolution computational fluid dynamic simulations and 4D flow MRI, which leads to more realistic velocity results. ML efforts have also focused on the automation of other post-processing steps, by learning phase corrections and anti-aliasing. To automate contour drawing and 3D segmentation, networks such as the U-Net have been widely applied. This review summarizes the latest ML advances in 4D flow MRI with a focus on technical aspects and applications. It is divided into the current status of fast and accurate 4D flow MRI data generation, ML based post-processing tools for phase correction and vessel delineation and the statistical evaluation of blood flow.
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Affiliation(s)
- Eva S. Peper
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland,*Correspondence: Eva S. Peper,
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands,Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bernd Jung
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jessica A. M. Bastiaansen
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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7
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Roos PR, Rijnberg FM, Westenberg JJM, Lamb HJ. Particle Tracing Based on
4D
Flow Magnetic Resonance Imaging: A Systematic Review into Methods, Applications, and Current Developments. J Magn Reson Imaging 2022; 57:1320-1339. [PMID: 36484213 DOI: 10.1002/jmri.28540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Particle tracing based on 4D Flow MRI has been applied as a quantitative and qualitative postprocessing technique to study temporally evolving blood flow patterns. PURPOSE To systematically review the various methods to perform 4D Flow MRI-based particle tracing, as well as the clinical value, clinical applications, and current developments of the technique. STUDY TYPE The study type is systematic review. SUBJECTS Patients with cardiovascular disease (such as Marfan, Fontan, Tetralogy of Fallot), healthy controls, and cardiovascular phantoms that received 4D Flow MRI with particle tracing. FIELD STRENGTH/SEQUENCE Three-dimensional three-directional cine phase-contrast MRI, at 1.5 T and 3 T. ASSESSMENT Two systematic searches were performed on the PubMed database using Boolean operators and the relevant key terms covering 4D Flow MRI and particle tracing. One systematic search was focused on particle tracing methods, whereas the other on applications. Additional articles from other sources were sought out and included after a similar inspection. Particle tracing methods, clinical applications, clinical value, and current developments were extracted. STATISTICAL TESTS The main results of the included studies are summarized, without additional statistical analysis. RESULTS Of 127 unique articles retrieved from the initial search, 56 were included (28 for methods and 54 for applications). Most articles that described particle tracing methods used an adaptive timestep, a fourth order Runge-Kutta integration method, and linear interpolation in the time dimension. Particle tracing was applied in heart chambers, aorta, venae cavae, Fontan circulation, pulmonary arteries, abdominal vasculature, peripheral arteries, carotid arteries, and cerebral vasculature. Applications were grouped as intravascular, intracardiac, flow stasis, and research. DATA CONCLUSIONS Particle tracing based on 4D Flow MRI gives unique insight into blood flow in several cardiovascular diseases, but the quality depends heavily on the MRI data quality. Further studies are required to evaluate the clinical value of the technique for different cardiovascular diseases. EVIDENCE LEVEL 5. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Paul R. Roos
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
| | - Friso M. Rijnberg
- Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
| | | | - Hildo J. Lamb
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
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Kollar SE, Udine ML, Mandell JG, Cross RR, Loke YH, Olivieri LJ. Impact of ferumoxytol vs gadolinium on 4D flow cardiovascular magnetic resonance measurements in small children with congenital heart disease. J Cardiovasc Magn Reson 2022; 24:58. [PMID: 36352454 PMCID: PMC9648014 DOI: 10.1186/s12968-022-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) allows for time-resolved three-dimensional phase-contrast (4D Flow) analysis of congenital heart disease (CHD). Higher spatial resolution in small infants requires thinner slices, which can degrade the signal. Particularly in infants, the choice of contrast agent (ferumoxytol vs. gadolinium) may influence 4D Flow CMR accuracy. Thus, we investigated the accuracy of 4D Flow CMR measurements compared to gold standard 2D flow phase contrast (PC) measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients with shunt lesions. METHODS This was a retrospective study consisting of CMR studies from complex CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D Flow and standard two-dimensional phase contrast (2D-PC) flow collected. 4D Flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins, and pulmonary veins. 4D Flow accuracy was defined as percent difference or correlation against conventional measurements (2D-PC) from the same vessels. Subgroup analysis was performed on two-ventricular vs single-ventricular CHD, arterial vs venous flow, as well as low flows (defined as < 1.5 L/min) in 1V CHD. RESULTS Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.6 vs. 2.3 ± 1.9 years, p = 0.70), patient body surface area (0.50 ± 0.2 vs. 0.52 ± 0.2 m2, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6 mm, p = 0.22). Ten CMR studies with single ventricular CHD were included. Overall, ferumoxytol-enhanced 4D flow CMR measurements demonstrated less percent difference to 2D-PC when compared to gadolinium-enhanced 4D Flow CMR studies. In subgroup analyses of arterial vs. venous flows (high velocity vs. low velocity) and low flow in single ventricle CHD, ferumoxytol-enhanced 4D Flow CMR measurements had stronger correlation to 2D-PC CMR. The contrast-to-noise ratio (CNR) in ferumoxytol-enhanced studies was higher than the CNR in gadolinium-enhanced studies. CONCLUSIONS Ferumoxytol-enhanced 4D Flow CMR has improved accuracy when compared to gadolinium 4D Flow CMR, particularly for infants with small vessels in CHD.
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Affiliation(s)
- Sarah E Kollar
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA.
| | - Michelle L Udine
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Jason G Mandell
- Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Russell R Cross
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Laura J Olivieri
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
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Soulat G, Scott MB, Pathrose A, Jarvis K, Berhane H, Allen B, Avery R, Alsate AR, Rigsby CK, Markl M. 4D flow MRI derived aortic hemodynamics multi-year follow-up in repaired coarctation with bicuspid aortic valve. Diagn Interv Imaging 2022; 103:418-426. [PMID: 35523699 PMCID: PMC11041270 DOI: 10.1016/j.diii.2022.04.003] [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: 12/20/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the relationships between hemodynamic parameters and longitudinal changes in aortic dimensions on four-dimensional (4D) flow magnetic resonance imaging (MRI) in patients with bicuspid aortic valve (BAV) and repaired coarctation. MATERIALS AND METHODS The study retrospectively included patients with BAV and childhood coarctation repair who had at least two cardiothoracic MRI examinations including 4D flow MRI at baseline and follow-up. Analysis included the calculation of aortic peak velocities, wall shear stress (WSS), pulse wave velocity (PWV), aortic dimensions and annual growth rates. Differences between examinations were assessed using paired t-test or Wilcoxon signed rank test. Relationships between growth rate and 4D flow metrics were assessed using Pearson or Spearman correlation tests. RESULTS The cohort included 15 patients (mean age 35 ± 8 [SD] years, 9 men) with a median follow-up time of 3.98 years (Q1: 2.10; Q3: 4.96). There were no significant differences in aortic mean WSS, peak velocities, and PWV between baseline and follow-up values. Greater baseline peak velocities at the site of the coarctation were strongly associated with aortic narrowing (follow-up vs. baseline diameter) at coarctation zone (r = -0.64; P = 0.010) and moderately in descending aorta (r = -0.53; P = 0.042). In addition, increased baseline WSS in the aortic arch was strongly related with narrowing of the coarctation zone at follow-up (r = -0.64, P = 0.011). CONCLUSION Measures of aortic hemodynamics and aortic WSS are stable over time in patients with BAV with coarctation repair. Increased peak velocity was associated with a progressive narrowing at the site of the coarctation repair.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Université Paris Centre, PARCC INSERM, 75015 Paris, France.
| | - Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Haben Berhane
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
| | - Bradley Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Alejandro Roldan Alsate
- Department of Mechanical Engineering, University of Wisconsin Madison, Madison 53706, WI, USA
| | - Cynthia K Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago 60611, IL, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
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Shahid L, Rice J, Berhane H, Rigsby C, Robinson J, Griffin L, Markl M, Roldán-Alzate A. Enhanced 4D Flow MRI-Based CFD with Adaptive Mesh Refinement for Flow Dynamics Assessment in Coarctation of the Aorta. Ann Biomed Eng 2022; 50:1001-1016. [PMID: 35624334 PMCID: PMC11034844 DOI: 10.1007/s10439-022-02980-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/11/2022] [Indexed: 01/28/2023]
Abstract
4D Flow MRI is a diagnostic tool that can visualize and quantify patient-specific hemodynamics and help interventionalists optimize treatment strategies for repairing coarctation of the aorta (COA). Despite recent developments in 4D Flow MRI, shortcomings include phase-offset errors, limited spatiotemporal resolution, aliasing, inaccuracies due to slow aneurysmal flows, and distortion of images due to metallic artifact from vascular stents. To address these limitations, we developed a framework utilizing Computational Fluid Dynamics (CFD) with Adaptive Mesh Refinement (AMR) that enhances 4D Flow MRI visualization/quantification. We applied this framework to five pediatric patients with COA, providing in-vivo and in-silico datasets, pre- and post-intervention. These two data sets were compared and showed that CFD flow rates were within 9.6% of 4D Flow MRI, which is within a clinically acceptable range. CFD simulated slow aneurysmal flow, which MRI failed to capture due to high relative velocity encoding (Venc). CFD successfully predicted in-stent blood flow, which was not visible in the in-vivo data due to susceptibility artifact. AMR improved spatial resolution by factors of 101 to 103 and temporal resolution four-fold. This computational framework has strong potential to optimize visualization/quantification of aneurysmal and in-stent flows, improve spatiotemporal resolution, and assess hemodynamic efficiency post-COA treatment.
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Affiliation(s)
- Labib Shahid
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Room 2476 WIMR II, Madison, WI, 53705, USA.
| | - James Rice
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Room 2476 WIMR II, Madison, WI, 53705, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Cynthia Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joshua Robinson
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lindsay Griffin
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Room 2476 WIMR II, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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11
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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12
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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13
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Zhang Y, Zhang R, Thomas N, Ullah AH, Eichholz B, Estevadeordal J, Suzen YB. Experimental and computational study of pulsatile flow characteristics in Romanesque and gothic aortic arch models. Med Eng Phys 2022; 102:103784. [DOI: 10.1016/j.medengphy.2022.103784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
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14
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Desai L, Stefek H, Berhane H, Robinson J, Rigsby C, Markl M. Four-Dimensional flow Magnetic Resonance Imaging for Assessment of Pediatric Coarctation of the Aorta. J Magn Reson Imaging 2022; 55:200-208. [PMID: 34173693 PMCID: PMC9084555 DOI: 10.1002/jmri.27802] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) typically requires repair, but re-interventions and vascular complications occur, particularly with associated defects like bicuspid aortic valve (BAV). Magnetic resonance imaging (MRI) may identify anatomic and hemodynamic factors contributing to clinical complications. PURPOSE To investigate 4D flow MRI characteristics in pediatric CoA to determine parameters for long-term clinical surveillance. STUDY TYPE Retrospective. POPULATION CoA (n = 21), CoA with BAV (n = 24), BAV alone (n = 29), and healthy control (n = 25). FIELD STRENGTH/SEQUENCE A 1.5 T, 3D CE IR FLASH MRA, 4D flow MRI using 3D time resolved PC-MRI with velocity encoding. ASSESSMENT Thoracic aorta diameters were measured from 3D CE-MRA. Peak systolic velocities and wall shear stress were calculated and flow patterns were visualized throughout the thoracic aorta using 4D flow. Repair characteristics, re-interventions, and need for anti-hypertensive medications were recorded. STATISTICS Descriptive statistics, ANOVA with post hoc t-testing and Bonferroni correction, Kruskal-Wallis H, intraclass correlation coefficient, Fleiss' kappa. RESULTS Patients with CoA with or without repair had smaller transverse arch diameters compared to BAV alone and control cohorts (P < 0.05), higher peak systolic flow velocities and wall shear stress compared to controls in the transverse arch and descending aorta (P < 0.05), and flow derangements in the descending aorta. The most common CoA repairs were extended end-to-end anastomosis (n = 22/45, 48.9%, age at repair 1 ± 2 years, seven re-interventions) and stent/interposition graft placement (n = 10/45, 22.2%, age at repair 12 ± 3 years, one re-intervention). Anti-hypertensive medications were prescribed to 33.3% (n = 15/45) of CoA and 34.4% of BAV alone patients (n = 10/29). DATA CONCLUSIONS Despite repair, CoA alters hemodynamics and flow patterns in the transverse arch and descending aorta. These findings may contribute to vascular remodeling and secondary complications. 4D flow MRI may be valuable in risk stratification, treatment selection and postintervention assessment. Long-term, prospective studies are warranted to correlate patient and MRI factors with clinical outcomes. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lajja Desai
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | | | - Haben Berhane
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Joshua Robinson
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Cynthia Rigsby
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
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15
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Corrado PA, Seiter DP, Wieben O. Automatic measurement plane placement for 4D Flow MRI of the great vessels using deep learning. Int J Comput Assist Radiol Surg 2022; 17:199-210. [PMID: 34403045 PMCID: PMC8851604 DOI: 10.1007/s11548-021-02475-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/03/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Despite the great potential and flexibility of 4D flow MRI for hemodynamic analysis, a major limitation is the need for time-consuming and user-dependent post-processing. We propose a fast four-step algorithm for rapid, robust, and repeatable flow measurements in the great vessels based on automatic placement of measurement planes and vessel segmentation. METHODS Our algorithm works by (1) subsampling the 3D image into 3D patches, (2) predicting the probability of each patch containing individual vessels and location/orientation of the vessel within the patch via a convolutional neural network, (3) selecting the predicted planes with highest probabilities for each vessel, and (4) shifting the plane centers to the maximum velocity within each plane. The method was trained on 283 scans and evaluated on 40 unseen scans by comparing algorithm-derived processing times, plane locations, and flow measurements to those of two manual observers (graduate students) using t-tests, Pearson correlation, and Bland-Altman analysis. RESULTS The average processing time for the algorithm (18 s) was shorter than observer 1 (362 s; P < 0.001) and observer 2 (317 s; P < 0.001). The distance between planes placed by the algorithm and those placed by manual observers was slightly greater (O1 vs. algorithm: 9.0 mm, O2 vs. algorithm: 10.3 mm) than the distance between planes placed by the two manual observers (8.3 mm). The correlation between flow values for planes placed by the algorithm and those placed by manual observers was slightly lower (O1 vs. algorithm: R = 0.68, O2 vs. algorithm: R = 0.72) than the flow correlation between the two manual observers (R = 0.81). CONCLUSION Our method is a feasible and accurate approach for fast, reproducible, and automated flow measurement and visualization in 4D flow MRI of the great vessels, with similar variability compared to a manual annotator as the variability between two manual observers. This approach could be applied in other anatomical regions.
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Affiliation(s)
- Philip A. Corrado
- Department of Medical Physics, University of Wisconsin-Madison,
Madison, Wisconsin, USA
| | - Daniel P. Seiter
- Department of Medical Physics, University of Wisconsin-Madison,
Madison, Wisconsin, USA
| | - Oliver Wieben
- Departments of Medical Physics and Radiology, University of
Wisconsin-Madison, Madison, Wisconsin, USA
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16
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van Ooij P, Farag ES, Blanken CPS, Nederveen AJ, Groenink M, Planken RN, Boekholdt SM. Fully quantitative mapping of abnormal aortic velocity and wall shear stress direction in patients with bicuspid aortic valves and repaired coarctation using 4D flow cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2021; 23:9. [PMID: 33588887 PMCID: PMC7885343 DOI: 10.1186/s12968-020-00703-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Helices and vortices in thoracic aortic blood flow measured with 4D flow cardiovascular magnetic resonance (CMR) have been associated with aortic dilation and aneurysms. Current approaches are semi-quantitative or when fully quantitative based on 2D plane placement. In this study, we present a fully quantitative and three-dimensional approach to map and quantify abnormal velocity and wall shear stress (WSS) at peak systole in patients with a bicuspid aortic valve (BAV) of which 52% had a repaired coarctation. METHODS 4D flow CMR was performed in 48 patients with BAV and in 25 healthy subjects at a spatiotemporal resolution of 2.5 × 2.5 × 2.5mm3/ ~ 42 ms and TE/TR/FA of 2.1 ms/3.4 ms/8° with k-t Principal Component Analysis factor R = 8. A 3D average of velocity and WSS direction was created for the normal subjects. Comparing BAV patient data with the 3D average map and selecting voxels deviating between 60° and 120° and > 120° yielded 3D maps and volume (in cm3) and surface (in cm2) quantification of abnormally directed velocity and WSS, respectively. Linear regression with Bonferroni corrected significance of P < 0.0125 was used to compare abnormally directed velocity volume and WSS surface in the ascending aorta with qualitative helicity and vorticity scores, with local normalized helicity (LNH) and quantitative vorticity and with patient characteristics. RESULTS The velocity volumes > 120° correlated moderately with the vorticity scores (R ~ 0.50, P < 0.001 for both observers). For WSS surface these results were similar. The velocity volumes between 60° and 120° correlated moderately with LNH (R = 0.66) but the velocity volumes > 120° did not correlate with quantitative vorticity. For abnormal velocity and WSS deviating between 60° and 120°, moderate correlations were found with aortic diameters (R = 0.50-0.70). For abnormal velocity and WSS deviating > 120°, additional moderate correlations were found with age and with peak velocity (stenosis severity) and a weak correlation with gender. Ensemble maps showed that more than 60% of the patients had abnormally directed velocity and WSS. Additionally, abnormally directed velocity and WSS was higher in the proximal descending aorta in the patients with repaired coarctation than in the patients where coarctation was never present. CONCLUSION The possibility to reveal directional abnormalities of velocity and WSS in 3D provides a new tool for hemodynamic characterization in BAV disease.
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Affiliation(s)
- Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Emile S. Farag
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Carmen P. S. Blanken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - R. Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - S. Matthijs Boekholdt
- Department of Cardiology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
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17
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High-degree Norwood neoaortic tapering is associated with abnormal flow conduction and elevated flow-mediated energy loss. J Thorac Cardiovasc Surg 2021; 162:1791-1804. [PMID: 33653609 DOI: 10.1016/j.jtcvs.2021.01.111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The Norwood neoaortic arch biomechanical properties are abnormal due to reduced vessel wall compliance and abnormal geometry. Others have previously described neoaortic geometric distortion by the degree of diameter reduction (tapering) and associated this with mismatched ventricular-neoaortic coupling, abnormal flow hemodynamic parameters, and worse patient outcome. Our purposes were to investigate the influence of neoaortic tapering (ie, diameter reduction) on flow-mediated viscous energy loss (EL') in post-Norwood palliated hypoplastic left heart syndrome patients, and correlate flow-geometry with single ventricle power generation. METHODS Twenty-six palliated hypoplastic left heart syndrome patients underwent comprehensive cardiac evaluation with 4-dimensional-flow magnetic resonance imaging. Patients were grouped into high- (group H, n = 13) and low- (group L, n = 13) degree neoaortic tapering using the median cutoff value of neoaortic diameter variance. EL' was calculated along standardized segments using 4-dimensional-flow magnetic resonance imaging. Flow-mediated power loss as a percentage of total power generated by the single ventricle was determined. RESULTS Group H had a higher prevalence of abnormal recirculating flow in the neoaorta and elevated neoaortic EL' in the ascending aorta (1.0 vs 0.6 mW; P = .004). Group H EL' was increased across the entire thoracic aorta (2.6 vs 1.3 mW; P = .002) and accounted for 0.7% of generated ventricular power versus 0.3% in group L (P = .024). EL' directly correlated with the degree of ascending aortic dilation (R = 0.49; P = .012). CONCLUSIONS Patients with high degree neoaortic tapering have more perturbed flow through the neoaorta and increased EL'. Flow-mediated energy loss due to abnormal flow represents irreversibly wasted power generated by the single right ventricle. In patients with high-degree neoaortic tapering, EL' was more than 2-fold greater than low-degree tapering patients. These data suggest that oversizing the Norwood neoaortic reconstruction should be avoided and that patients with distorted neoaortic geometry may warrant increased surveillance for single-ventricle deterioration.
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18
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Settecase F, Rayz VL. Advanced vascular imaging techniques. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:81-105. [DOI: 10.1016/b978-0-444-64034-5.00016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Assessment of hemodynamic responses to exercise in aortic coarctation using MRI-ergometry in combination with computational fluid dynamics. Sci Rep 2020; 10:18894. [PMID: 33144605 PMCID: PMC7609559 DOI: 10.1038/s41598-020-75689-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/16/2020] [Indexed: 01/16/2023] Open
Abstract
In patients with aortic coarctation it would be desirable to assess pressure gradients as well as information about blood flow profiles at rest and during exercise. We aimed to assess the hemodynamic responses to physical exercise by combining MRI-ergometry with computational fluid dynamics (CFD). MRI was performed on 20 patients with aortic coarctation (13 men, 7 women, mean age 21.5 ± 13.7 years) at rest and during ergometry. Peak systolic pressure gradients, wall shear stress (WSS), secondary flow degree (SFD) and normalized flow displacement (NFD) were calculated using CFD. Stroke volume was determined based on MRI. On average, the pressure gradient was 18.0 ± 16.6 mmHg at rest and increased to 28.5 ± 22.6 mmHg (p < 0.001) during exercise. A significant increase in cardiac index was observed (p < 0.001), which was mainly driven by an increase in heart rate (p < 0.001). WSS significantly increased during exercise (p = 0.006), whereas SFD and NFD remained unchanged. The combination of MRI-ergometry with CFD allows assessing pressure gradients as well as flow profiles during physical exercise. This concept has the potential to serve as an alternative to cardiac catheterization with pharmacological stress testing and provides hemodynamic information valuable for studying the pathophysiology of aortic coarctation.
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20
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Pathrose A, Ma L, Berhane H, Scott MB, Chow K, Forman C, Jin N, Serhal A, Avery R, Carr J, Markl M. Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease. Magn Reson Med 2020; 85:2174-2187. [PMID: 33107141 DOI: 10.1002/mrm.28561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To systematically assess the feasibility and performance of a highly accelerated compressed sensing (CS) 4D flow MRI framework at three different acceleration factors (R) for the quantification of aortic flow dynamics and wall shear stress (WSS) in patients with aortic disease. METHODS Twenty patients with aortic disease (58 ± 15 y old; 19 M) underwent four 4D flow scans: one conventional (GRAPPA, R = 2) and three CS 4D flows with R = 5.7, 7.7, and 10.2. All scans were acquired with otherwise equivalent imaging parameters on a 1.5T scanner. Peak-systolic velocity (Vmax ), peak flow (Qmax ), and net flow (Qnet ) were quantified at the ascending aorta (AAo), arch, and descending aorta (DAo). WSS was calculated at six regions within the AAo and arch. RESULTS Mean scan times for the conventional and CS 4D flows with R = 5.7, 7.7, and 10.2 were 9:58 ± 2:58 min, 3:40 ± 1:19 min, 2:50 ± 0:56 min, and 2:05 ± 0:42 min, respectively. Vmax , Qmax , and Qnet were significantly underestimated by all CS protocols (underestimation ≤ -7%, -9%, and -10% by CS, R = 5.7, 7.7, and 10.2, respectively). WSS measurements showed the highest underestimation by all CS protocols (underestimation ≤ -9%, -12%, and -14% by CS, R = 5.7, 7.7, and 10.2). CONCLUSIONS Highly accelerated aortic CS 4D flow at R = 5.7, 7.7, and 10.2 showed moderate agreement with the conventional 4D flow, despite systematically underestimating various hemodynamic parameters. The shortened scan time may enable the clinical translation of CS 4D flow, although potential hemodynamic underestimation should be considered when interpreting the results.
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Affiliation(s)
- Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Liliana Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Haben Berhane
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Kelvin Chow
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | | | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Ali Serhal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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21
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Lim MS, Bannon PG, Celermajer DS. Bicuspid aortic valve: different clinical profiles for subjects with versus without repaired aortic coarctation. Open Heart 2020; 7:openhrt-2020-001429. [PMID: 33051336 PMCID: PMC7555085 DOI: 10.1136/openhrt-2020-001429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023] Open
Abstract
Objectives A small proportion of patients undergoing bicuspid aortic valve (BAV) intervention have had prior repair of aortic coarctation (CoA). We aimed to describe phenotypic differences between BAV patients, comparing those with versus those without previous coarctation repair. Methods 556 adults with BAV who had undergone aortic valve and/or ascending aortic surgery were identified, and relevant clinical and operative details were retrospectively analysed. Results Of the total cohort, 532 patients (95.7%) had isolated BAV (‘BAV-only’), and 24 (4.3%) had had a previous successful CoA repair (‘BAV-CoA’). The median age at surgery was significantly lower in BAV-CoA patients compared with BAV-only (median, IQR: 40 years, 26–57 vs 62 years, 51–69, p<0.001). Indications for surgery also differed, with BAV-CoA patients much more likely to undergo surgery for aortic regurgitation (BAV-CoA 38% vs BAV-only 13%, p<0.001); patients with isolated BAV were more likely to require surgery for aortic stenosis (BAV-only 75% vs BAV-CoA 50%, p<0.001). Two different BAV morphotypes were commoner in the BAV-CoA group; type 0 valves (24% vs 8%, p<0.05) and type 2 valves (12% vs 3%, p<0.05). The proportion of patients undergoing concomitant aortic surgery at the time of valve surgery were similar (BAV-only 38% vs BAV-CoA 42%, p=0.8). Conclusion In adult patients undergoing aortic valve surgery for BAV disease, those with a prior history of repaired CoA underwent surgery at a very much younger age, and a higher proportion required intervention for aortic regurgitation.
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Affiliation(s)
- Michelle S Lim
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Paul G Bannon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David S Celermajer
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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22
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Catapano F, Pambianchi G, Cundari G, Rebelo J, Cilia F, Carbone I, Catalano C, Francone M, Galea N. 4D flow imaging of the thoracic aorta: is there an added clinical value? Cardiovasc Diagn Ther 2020; 10:1068-1089. [PMID: 32968661 DOI: 10.21037/cdt-20-452] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Four-dimensional (4D) flow MRI has emerged as a powerful non-invasive technique in cardiovascular imaging, enabling to analyse in vivo complex flow dynamics models by quantifying flow parameters and derived features. Deep knowledge of aortic flow dynamics is fundamental to better understand how abnormal flow patterns may promote or worsen vascular diseases. In the perspective of an increasingly personalized and preventive medicine, growing interest is focused on identifying those quantitative functional features which are early predictive markers of pathological evolution. The thoracic aorta and its spectrum of diseases, as the first area of application and development of 4D flow MRI and supported by an extensive experimental validation, represents the ideal model to introduce this technique into daily clinical practice. The purpose of this review is to describe the impact of 4D flow MRI in the assessment of the thoracic aorta and its most common affecting diseases, providing an overview of the actual clinical applications and describing the potential role of derived advanced hemodynamic measures in tailoring follow-up and treatment.
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Affiliation(s)
- Federica Catapano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.,Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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23
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Yurpolskaya LA, Shlyappo MA, Makarenko VN, Svobodov AA, Levchenko EG, Makarenko MV, Poromov AA. [4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery]. ACTA ACUST UNITED AC 2020; 60:54-64. [PMID: 33155959 DOI: 10.18087/cardio.2020.8.n1094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
Aim Comprehensive evaluation of blood flow in the thoracic aorta using a software for 4D processing of magnetic resonance (MR) images of the heart and blood vessels (4D Flow) in patients with aortic coarctation in the late postoperative period.Materials and methods The MR study of the heart was performed for 10 patients (7 boys and 3 girls) aged 8 to 13 years (median, 9.5 [8.3; 10.8] years) who underwent resection with end-to-end anastomosis for aortic coarctation at age of 2 weeks to 10 months. MR tomography was performed on a 1.5 T MR scanner using a multichannel surface coil for scanning, electrocardiographic synchronization, and a specialized package of pulse sequences for scanning of the heart. Blood flow was evaluated with a 4D data handling software for processing of MR images of heart and blood vessels (4D Flow). The following blood flow parameters were analyzed: blood flow volume per second, peak blood flow velocity, peak and minimum blood flow area at the levels of ascending aorta, arch, isthmus, and descending aorta, and pressure gradient at the level of maximum narrowing of the aorta. 3D-MR images were used for evaluation of aortic geometry. Blood flow formation, distribution, and trajectories were analyzed by maps of vectors, particle trace, and stream lines. Statistical analysis was performed with a Statistica (v. 6.0 StatSoft Inc.) package.Results Accelerated flow in the region of residual aortic stenosis in systole was observed in all patients; 4 patients had an additional vortex flow below the aortic stenosis and a spiral flow in the descending aorta. The pressure gradient on the aortic isthmus was directly correlated with the left ventricular myocardial mass index (r=0.65; р=0.04) and indexes of blood flow in the ascending and descending aorta (р=0.03; р=0.026). No significant correlation was found for blood flow indexes and geometry of the aortic arch (H / L). Delayed contrast enhancement MR imaging did not detect any fibrotic changes in the myocardium in only one patient. The fibrosis severity inversely correlated with the right ventricular ejection fraction (r=0.65; р=0.04) and directly correlated with the pressure gradient at the aortic isthmus (r=0.63; p=0.05).Conclusion The 4D MR image processing software for the heart and blood vessels allows studying the blood flow in detail under natural conditions, provides potential advantages in comprehensive evaluation of patients with aortic coarctation during a dynamic follow-up. For a definitive conclusion about the relationship between the altered blood flow in the thoracic aorta and markers of residual, post-correction pathology, larger studies are required as well as long-term follow-up of patients with documented pathological patterns of blood flow (changes in blood flow velocity and volume throughout the entire thoracic aorta in combination with disorders in the normal flow geometry during the cardiac cycle).
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Affiliation(s)
- L A Yurpolskaya
- A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow
| | - M A Shlyappo
- A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow
| | - V N Makarenko
- A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow
| | - A A Svobodov
- A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow
| | - E G Levchenko
- A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow
| | - M V Makarenko
- A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow
| | - A A Poromov
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
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24
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Rizk J. 4D flow MRI applications in congenital heart disease. Eur Radiol 2020; 31:1160-1174. [PMID: 32870392 DOI: 10.1007/s00330-020-07210-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
Advances in the diagnosis and management of congenital heart disease (CHD) have resulted in a growing population of patients surviving well into adulthood and requiring lifelong follow-up. Flow quantification is a central component in the assessment of patients with CHD. 4D flow magnetic resonance imaging (MRI) has emerged as a tool that enables comprehensive study of flow. It involves the acquisition of a three-dimensional time-resolved volume with velocity encoding in all three spatial directions along the cardiac cycle. This allows flow quantification and visualization of blood flow patterns as well as the study of advanced hemodynamic parameters as kinetic energy and wall shear stress. 4D flow MRI-based study of flow has given insight into the altered hemodynamics in CHD particularly in bicuspid aortic valve disease and Fontan circulation. The aim of this review is to discuss the expanding clinical and research applications of 4D flow MRI in CHD as well its limitations.Key Points• Three-dimensional velocity encoding allows not only flow quantification but also the visualization of multidirectional flow patterns and the study of advanced hemodynamic parameters.• 4D flow MRI has added insight into the abnormal hemodynamics involved in congenital heart disease in particular in bicuspid aortic valve and Fontan circulation.• The main limitation of 4D flow MRI in congenital heart disease is the relatively long scan duration required for the complete coverage of the heart and great vessels with adequate spatiotemporal resolution.
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Affiliation(s)
- Judy Rizk
- Department of Cardiology, Faculty of Medicine, Alexandria University, El-Khartoum Square, Alexandria, 21521, Egypt.
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25
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Cardiac magnetic resonance imaging and computed tomography for the pediatric cardiologist. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Abstract
Magnetic resonance imaging (MRI) has become an important tool for the clinical evaluation of patients with cardiac and vascular diseases. Since its introduction in the late 1980s, quantitative flow imaging with MRI has become a routine part of standard-of-care cardiothoracic and vascular MRI for the assessment of pathological changes in blood flow in patients with cardiovascular disease. More recently, time-resolved flow imaging with velocity encoding along all three flow directions and three-dimensional (3D) anatomic coverage (4D flow MRI) has been developed and applied to enable comprehensive 3D visualization and quantification of hemodynamics throughout the human circulatory system. This article provides an overview of the use of 4D flow applications in different cardiac and vascular regions in the human circulatory system, with a focus on using 4D flow MRI in cardiothoracic and cerebrovascular diseases.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois 60208, USA
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27
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Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol 2020; 12:167-191. [PMID: 32547712 PMCID: PMC7284000 DOI: 10.4330/wjc.v12.i5.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Hospital, Children's Heart Center, Phoenix, AZ 85016, United States
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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28
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Four-dimensional Flow Magnetic Resonance Imaging Quantification of Blood Flow in Bicuspid Aortic Valve. J Thorac Imaging 2020; 35:383-388. [PMID: 32453278 DOI: 10.1097/rti.0000000000000535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Four-dimensional (D) flow magnetic resonance imaging (MRI) is limited by time-consuming and nonstandardized data analysis. We aimed to test the efficiency and interobserver reproducibility of a dedicated 4D flow MRI analysis workflow. MATERIALS AND METHODS Thirty retrospectively identified patients with bicuspid aortic valve (BAV, age=47.8±11.8 y, 9 male) and 30 healthy controls (age=48.8±12.5 y, 21 male) underwent Aortic 4D flow MRI using 1.5 and 3 T MRI systems. Two independent readers performed 4D flow analysis on a dedicated workstation including preprocessing, aorta segmentation, and placement of four 2D planes throughout the aorta for quantification of net flow, peak velocity, and regurgitant fraction. 3D flow visualization using streamlines was used to grade aortic valve outflow jets and extent of helical flow. RESULTS 4D flow analysis workflow time for both observers: 5.0±1.4 minutes per case (range=3 to 10 min). Valve outflow jets and flow derangement was visible in all 30 BAV patients (both observers). Net flow, peak velocity, and regurgitant fraction was significantly elevated in BAV patients compared with controls except for regurgitant fraction in plane 4 (91.1±29.7 vs. 62.6±19.6 mL/s, 37.1% difference; 121.7±49.7 vs. 90.9±26.4 cm/s, 28.9% difference; 9.3±10.1% vs. 2.0±3.4%, 128.0% difference, respectively; P<0.001). Excellent intraclass correlation coefficient agreement for net flow: 0.979, peak velocity: 0.931, and regurgitant fraction: 0.928. CONCLUSION Our study demonstrates the potential of an efficient data analysis workflow to perform standardized 4D flow MRI processing in under 10 minutes and with good-to-excellent reproducibility for flow and velocity quantification in the thoracic aorta.
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29
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Wang T, Pfeiffer T, Daemen J, Mastik F, Wieser W, van der Steen AFW, Huber R, van Soest G. Simultaneous Morphological and Flow Imaging Enabled by Megahertz Intravascular Doppler Optical Coherence Tomography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1535-1544. [PMID: 31725370 DOI: 10.1109/tmi.2019.2948258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We demonstrate three-dimensional intravascular flow imaging compatible with routine clinical image acquisition workflow by means of megahertz (MHz) intravascular Doppler Optical Coherence Tomography (OCT). The OCT system relies on a 1.1 mm diameter motorized imaging catheter and a 1.5 MHz Fourier Domain Mode Locked (FDML) laser. Using a post processing method to compensate the drift of the FDML laser output, we can resolve the Doppler phase shift between two adjoining OCT A-line datasets. By interpretation of the velocity field as measured around the zero phase shift, the flow direction at specific angles can be qualitatively estimated. Imaging experiments were carried out in phantoms, micro channels, and swine coronary artery in vitro at a speed of 600 frames/s. The MHz wavelength sweep rate of the OCT system allows us to directly investigate flow velocity of up to 37.5 cm/s while computationally expensive phase-unwrapping has to be applied to measure such high speed using conventional OCT system. The MHz sweep rate also enables a volumetric Doppler imaging even with a fast pullback at 40 mm/s. We present the first simultaneously recorded 3D morphological images and Doppler flow profiles. Flow pattern estimation and three-dimensional structural reconstruction of entire coronary artery are achieved using a single OCT pullback dataset.
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30
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Johnson EMI, Heller JA, Garcia Vicente F, Sarnari R, Gordon D, McCarthy PM, Barker AJ, Etemadi M, Markl M. Detecting Aortic Valve-Induced Abnormal Flow with Seismocardiography and Cardiac MRI. Ann Biomed Eng 2020; 48:1779-1792. [PMID: 32180050 DOI: 10.1007/s10439-020-02491-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/09/2020] [Indexed: 01/01/2023]
Abstract
Cardiac MRI (CMR) techniques offer non-invasive visualizations of cardiac morphology and function. However, imaging can be time-consuming and complex. Seismocardiography (SCG) measures physical vibrations transmitted through the chest from the beating heart and pulsatile blood flow. SCG signals can be acquired quickly and easily, with inexpensive electronics. This study investigates relationships between CMR metrics of function and SCG signal features. Same-day CMR and SCG data were collected from 28 healthy adults and 6 subjects with aortic valve disease history. Correlation testing and statistical median/decile calculations were performed with data from the healthy cohort. MR-quantified flow and function parameters in the healthy cohort correlated with particular SCG energy levels, such as peak aortic velocity with low-frequency SCG (coefficient 0.43, significance 0.02) and peak flow with high-frequency SCG (coefficient 0.40, significance 0.03). Valve disease-induced flow abnormalities in patients were visualized with MRI, and corresponding abnormalities in SCG signals were identified. This investigation found significant cross-modality correlations in cardiac function metrics and SCG signals features from healthy subjects. Additionally, through comparison to normative ranges from healthy subjects, it observed correspondences between pathological flow and abnormal SCG. This may support development of an easy clinical test used to identify potential aortic flow abnormalities.
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Affiliation(s)
- Ethan M I Johnson
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Tech E310, Evanston, IL, 60208, USA.
| | - J Alex Heller
- Department of Anesthesiology, Northwestern University, 676 N St Clair St, Suite 10, Chicago, IL, 60611, USA
| | - Florencia Garcia Vicente
- Department of Anesthesiology, Northwestern University, 676 N St Clair St, Suite 10, Chicago, IL, 60611, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
| | - Daniel Gordon
- Department of Radiology, Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Alex J Barker
- Department of Radiology, Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
| | - Mozziyar Etemadi
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Tech E310, Evanston, IL, 60208, USA.,Department of Anesthesiology, Northwestern University, 676 N St Clair St, Suite 10, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Tech E310, Evanston, IL, 60208, USA.,Department of Radiology, Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL, 60611, USA
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31
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Scott MB, Huh H, van Ooij P, Chen V, Herrera B, Elbaz M, McCarthy P, Malaisrie SC, Carr J, Fedak PWM, Markl M, Barker AJ. Impact of age, sex, and global function on normal aortic hemodynamics. Magn Reson Med 2020; 84:2088-2102. [PMID: 32162416 DOI: 10.1002/mrm.28250] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/10/2020] [Accepted: 02/14/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE To examine the effects of age, sex, and left ventricular global function on velocity, helicity, and 3D wall shear stress (3D-WSS) in the aorta of N = 100 healthy controls. METHODS Fifty female and 50 male volunteers with no history of cardiovascular disease, with 10 volunteers per age group (18-30, 31-40, 41-50, 51-60, and 61-80 years) underwent aortic 4D-flow MRI. Quantification of systolic aortic peak velocity, helicity, and 3D-WSS distribution and the calculation of age group-averaged peak systolic velocity and 3D-WSS maps ("atlases") were computed. Age-related and sex-related changes in peak velocity, helicity, and 3D-WSS were computed and correlated with standard metrics of left ventricular function derived from short-axis cine MRI. RESULTS No significant differences were found in peak systolic velocity or 3D-WSS based on sex except for the 18- to 30-year-old group (males 8% higher velocity volume and 3D-WSS surface area). Between successively older groups, systolic velocity decreased (13%, <1%, 7%, and 55% of the aorta volume) and 3D-WSS decreased (21%, 2%, 30%, and 62% of the aorta surface area). Mean velocity, mean 3D-3D-WSS, and median helicity increased with cardiac output (r = 0.27-0.43, all P < .01), and mean velocity and 3D-WSS decreased with increasing diameter (r > 0.35, P < .001). Arch and descending aorta systolic mean velocity, mean 3D-WSS, and median helicity increased with normalized left ventricular volumes: end diastolic volume (r = 0.31-0.37, P < .01), end systolic volume (r = 0.27-0.35, P < .01), and stroke volume (r = 0.28-0.35, P < .01). CONCLUSION Healthy aortic hemodynamics are dependent on subject age, and correlate with vessel diameter and cardiac function.
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Affiliation(s)
- Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Hyungkyu Huh
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - Vincent Chen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brenda Herrera
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mohammed Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patrick McCarthy
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Chris Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul W M Fedak
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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32
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Jarral OA, Tan MKH, Salmasi MY, Pirola S, Pepper JR, O'Regan DP, Xu XY, Athanasiou T. Phase-contrast magnetic resonance imaging and computational fluid dynamics assessment of thoracic aorta blood flow: a literature review. Eur J Cardiothorac Surg 2020; 57:438-446. [PMID: 31638698 DOI: 10.1093/ejcts/ezz280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 11/14/2022] Open
Abstract
The death rate from thoracic aortic disease is on the rise and represents a growing global health concern as patients are often asymptomatic before acute events, which have devastating effects on health-related quality of life. Biomechanical factors have been found to play a major role in the development of both acquired and congenital aortic diseases. However, much is still unknown and translational benefits of this knowledge are yet to be seen. Phase-contrast cardiovascular magnetic resonance imaging of thoracic aortic blood flow has emerged as an exceptionally powerful non-invasive tool enabling visualization of complex flow patterns, and calculation of variables such as wall shear stress. This has led to multiple new findings in the areas of phenotype-dependent bicuspid valve flow patterns, thoracic aortic aneurysm formation and aortic prosthesis performance assessment. Phase-contrast cardiovascular magnetic resonance imaging has also been used in conjunction with computational fluid modelling techniques to produce even more sophisticated analyses, by allowing the calculation of haemodynamic variables with exceptional temporal and spatial resolution. Translationally, these technologies may potentially play a major role in the emergence of precision medicine and patient-specific treatments in patients with aortic disease. This clinically focused review will provide a systematic overview of key insights from published studies to date.
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Affiliation(s)
- Omar A Jarral
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew K H Tan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, UK
| | - John R Pepper
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Xiao Y Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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33
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Gaur L, Kutty S. Surveillance of Repaired Aortic Coarctation: The Quest for a Better Index of Left Ventricular Afterload. Circ Cardiovasc Imaging 2020; 13:e010426. [PMID: 32069117 DOI: 10.1161/circimaging.120.010426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lasya Gaur
- The Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD
| | - Shelby Kutty
- The Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD
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OLIVEIRA DIANAC, LARANJO SÉRGIO, TIAGO JORGE, PINTO FÁTIMAF, SEQUEIRA ADÉLIA. NUMERICAL SIMULATION OF DILATION PATTERNS OF THE ASCENDING AORTA IN AORTOPATHIES. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519419500684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aortic dilation is associated with congenital bicuspid aortic valve (BAV) disease, and its etiology is still not completely understood. The aim of this study is to provide further insight into aortic hemodynamics in a BAV population with different degrees of aortic dilation and regurgitation in comparison with a patient without pathology. A fluid–structure interaction (FSI) numerical approach is implemented regarding patient-specific geometries, where the aortic valves are defined by analytical orifices. Results show that, while the patient without pathology displays a typical hemodynamic behavior of flows in bends, BAV-related aortas present an accelerated flow along the outer aortic wall. Wall shear stress (WSS) overload in the outer curvature is observed, more marked in more dilated aortas. Moreover, helices in the ascending aorta are present in these patients, enhanced with greater dilation. These findings support the fact that hemodynamic factors play an important role in aortic dilation onset and development in BAV patients, caused by a prolonged exposure of the outer ascending aortic curvature to altered WSS. Besides, our results suggest that greater aortic regurgitation may be associated with abnormal WSS distributions in the ascending aorta during diastole, which can facilitate aortic root dilation.
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Affiliation(s)
- DIANA C. OLIVEIRA
- Department of Bioengineering and CEMAT, Instituto Superior Técnico, Ulisboa Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal
| | - SÉRGIO LARANJO
- Pediatric Cardiology Department, Congenital Heart Diseases Reference Centre, Hospital de Santa Marta (CHLC), Rua de Santa Marta 50 1169-024 Lisboa, Portugal
| | - JORGE TIAGO
- Department of Mathematics and CEMAT, Instituto Superior Técnico, Ulisboa Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal
| | - FÁTIMA F. PINTO
- Pediatric Cardiology Department, Congenital Heart Diseases Reference Centre, Hospital de Santa Marta (CHLC), Rua de Santa Marta 50 1169-024 Lisboa, Portugal
| | - ADÉLIA SEQUEIRA
- Department of Mathematics and CEMAT, Instituto Superior Técnico, Ulisboa Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal
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Viola F, Dyverfeldt P, Carlhäll CJ, Ebbers T. Data Quality and Optimal Background Correction Order of Respiratory-Gated k-Space Segmented Spoiled Gradient Echo (SGRE) and Echo Planar Imaging (EPI)-Based 4D Flow MRI. J Magn Reson Imaging 2019; 51:885-896. [PMID: 31332874 PMCID: PMC7027768 DOI: 10.1002/jmri.26879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 12/23/2022] Open
Abstract
Background A reduction in scan time of 4D Flow MRI would facilitate clinical application. A recent study indicates that echo‐planar imaging (EPI) 4D Flow MRI allows for a reduction in scan time and better data quality than the recommended k‐space segmented spoiled gradient echo (SGRE) sequence. It was argued that the poor data quality of SGRE was related to the nonrecommended absence of respiratory motion compensation. However, data quality can also be affected by the background offset compensation. Purpose To compare the data quality of respiratory motion‐compensated SGRE and EPI 4D Flow MRI and their dependence on background correction (BC) order. Study Type Retrospective. Subjects Eighteen healthy subjects (eight female, mean age 32 ± 5 years). Field Strength and Sequence 1.5 T. [Correction added on July 26, 2019, after first online publication: The preceding field strength was corrected.] SGRE and EPI‐based 4D Flow MRI. Assessment Data quality was investigated visually and by comparing flows through the cardiac valves and aorta. Measurements were obtained from transvalvular flow and pathline analysis. Statistical Tests Linear regression and Bland–Altman analysis were used. Wilcoxon test was used for comparison of visual scoring. Student's t‐test was used for comparison of flow volumes. Results No significant difference was found by visual inspection (P = 0.08). Left ventricular (LV) flows were strongly and very strongly associated with SGRE and EPI, respectively (R2 = 0.86–0.94 SGRE; 0.71–0.79 EPI, BC0–4). LV and right ventricular (RV) outflows and LV pathline flows were very strongly associated (R2 = 0.93–0.95 SGRE; 0.88–0.91 EPI, R2 = 0.91–0.95 SGRE; 0.91–0.93 EPI, BC1–4). EPI LV outflow was lower than the short‐axis‐based stroke volume. EPI RV outflow and proximal descending aortic flow were lower than SGREs. Data Conclusion Both sequences yielded good internal data consistency when an adequate background correction was applied. Second and first BC order were considered sufficient for transvalvular flow analysis in SGRE and EPI, respectively. Higher BC orders were preferred for particle tracing. Level of Evidence 4 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2020;51:885–896.
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Affiliation(s)
- Federica Viola
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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4-Dimensional Velocity Mapping Cardiac Magnetic Resonance of Extracardiac Bypass for Aortic Coarctation Repair. JACC Case Rep 2019; 1:17-20. [PMID: 34316733 PMCID: PMC8288760 DOI: 10.1016/j.jaccas.2019.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
This report describes a case of a young lady who, following extracardiac bypass between ascending and descending aorta for severe aortic coarctation, underwent 4-dimensional flow cardiac magnetic resonance, a technique that, by 3-dimensional flow assessment over time (4-dimensional), allows not only quantification of flows but also wall shear stress. In this case, increased wall shear stress was observed in the conduit's acute angle (kinking) as well as at the distal anastomosis level. The authors postulate that increased wall shear stress could help identify and risk stratify adult congenital heart disease who could develop vascular complications in the future. (Level of Difficulty: Intermediate.)
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Ordovas K. Invited Commentary on “Four-dimensional Flow MRI,” with Response from Dr Azarine et al. Radiographics 2019; 39:648-650. [DOI: 10.1148/rg.2019190035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Karen Ordovas
- Department of Radiology, University of California, San Francisco San Francisco, California
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Azarine A, Garçon P, Stansal A, Canepa N, Angelopoulos G, Silvera S, Sidi D, Marteau V, Zins M. Four-dimensional Flow MRI: Principles and Cardiovascular Applications. Radiographics 2019; 39:632-648. [PMID: 30901284 DOI: 10.1148/rg.2019180091] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In-plane phase-contrast (PC) imaging is now a routine component of MRI of regional blood flow in the heart and great vessels. In-plane PC MRI provides a volumetric, isotropic, time-resolved cine sequence that enables three-directional velocity encoding, a technique known as four-dimensional (4D) flow MRI. Recent advances in 4D flow MRI have shortened imaging times, while progress in big-data processing has improved dataset pre- and postprocessing, thereby increasing the feasibility of 4D flow MRI in clinical practice. Important technical issues include selection of the optimal velocity-encoding sensitivity before acquisition and preprocessing of the raw data for phase-offset corrections. Four-dimensional flow MRI provides unprecedented capabilities for comprehensive analysis of complex blood flow patterns using new visualization tools such as streamlines and velocity vectors. Retrospective multiplanar navigation enables flexible retrospective flow quantification through any plane across the volume with good accuracy. Current flow parameters include forward flow, reverse flow, regurgitation fraction, and peak velocity. Four-dimensional flow MRI also supplies advanced flow parameters of use for research, such as wall shear stress. The vigorous burgeoning of new applications indicates that 4D flow MRI is becoming an important imaging modality for cardiovascular disorders. This article reviews the main technical issues of 4D flow MRI and the different parameters provided by it and describes the main applications in cardiovascular diseases, including congenital heart disease, cardiac valvular disease, aortic disease, and pulmonary hypertension. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by Ordovas .
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Affiliation(s)
- Arshid Azarine
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Philippe Garçon
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Audrey Stansal
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Nadia Canepa
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Giorgios Angelopoulos
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Stephane Silvera
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Daniel Sidi
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Véronique Marteau
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
| | - Marc Zins
- From the Departments of Medical Imaging (A.A., N.C., G.A., S.S., V.M., M.Z.), Cardiology (P.G.), and Vascular Medicine (A.S.), Saint Joseph Hospital, 185 rue Raymond Losserand, 75014 Paris, France; and Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France (D.S.)
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Katahashi K, Sano M, Takehara Y, Inuzuka K, Sugiyama M, Alley MT, Takeuchi H, Unno N. Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis. J Vasc Surg 2019; 70:107-116.e1. [PMID: 30792053 DOI: 10.1016/j.jvs.2018.09.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/29/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the hemodynamic parameters of type II endoleaks (T2ELs) to predict sac expansion using four-dimensional flow-sensitive magnetic resonance imaging (4D-flow MRI) analysis. METHODS Patients who underwent endovascular aneurysm repair (EVAR) and were diagnosed with a T2EL were included in the study. Using 4D-flow MRI at 7 days, the peak flow velocity and amplitude of dynamics of blood flow per minute were measured in each T2EL vessel. The peak flow velocity was defined as the maximum of the absolute value of the blood flow velocity. The amplitude of dynamics of blood flow in the tributary arteries was defined as the sum of the absolute values of the inflow and outflow volume in each vessel. The amplitude of dynamics of blood flow in the tributary arteries per sac was calculated in each sac. The aneurysm sac diameter was measured by computed tomography (CT) at 1 year. The patients were divided into two groups according to the presence or absence of sac expansion. RESULTS Of 155 patients who underwent EVAR, both CT angiography and 4D-flow MRI were performed in 107 patients at 7 days after EVAR. Among them, 39 (36.4%) were found to have a T2EL, of whom 28 were re-evaluated with CT angiography and 4D-flow at 1 year; 7 patients had expanding sacs (expanding group), whereas 21 had nonexpanding sacs (not-expanding group). At 7 days, 28 patients had 80 T2EL vessels detected by 4D-flow MRI, of which 39 vessels (48.8%) had stopped flowing at 1 year (transient vessels); 41 vessels (51.3%) had sustained flow (persistent vessels). The persistent vessels had significantly larger peak flow velocity and amplitude of dynamics of blood flow. The comprehensive analysis of T2EL vessels per sac identified that the amplitude of dynamics of blood flow in the tributary arteries per sac was significantly higher in the expanding group than in the not-expanding group. A receiver operating characteristic curve analysis revealed that the sensitivity and specificity of sac enlargement at a cutoff value of 3750 mm3/min were 85.7% and 76.2%, respectively. CONCLUSIONS The fate of aneurysm sacs with T2ELs after EVAR has remained difficult to predict. A comprehensive analysis of concurrent multiple T2EL vessels using 4D-flow MRI analysis may enable prediction of the sac expansion after EVAR.
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Affiliation(s)
- Kazuto Katahashi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masaki Sano
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Kazunori Inuzuka
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masataka Sugiyama
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Marcus T Alley
- Department of Radiology, Stanford University, Palo Alto, Calif
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Unno
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Wehrum T, Guenther F, Fuchs A, Schuchardt F, Hennemuth A, Harloff A. Measurement of cardiac valve and aortic blood flow velocities in stroke patients: a comparison of 4D flow MRI and echocardiography. Int J Cardiovasc Imaging 2018; 34:939-946. [DOI: 10.1007/s10554-018-1298-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
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Montalba C, Urbina J, Sotelo J, Andia ME, Tejos C, Irarrazaval P, Hurtado DE, Valverde I, Uribe S. Variability of 4D flow parameters when subjected to changes in MRI acquisition parameters using a realistic thoracic aortic phantom. Magn Reson Med 2017; 79:1882-1892. [DOI: 10.1002/mrm.26834] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/02/2017] [Accepted: 06/19/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Cristian Montalba
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
| | - Jesus Urbina
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of RadiologySchool of Medicine, Pontificia Universidad Católica de ChileSantiago Chile
| | - Julio Sotelo
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Electrical EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Marcelo E. Andia
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of RadiologySchool of Medicine, Pontificia Universidad Católica de ChileSantiago Chile
| | - Cristian Tejos
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Electrical EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Pablo Irarrazaval
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Electrical EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Daniel E. Hurtado
- Department of Structural and Geotechnical EngineeringPontificia Universidad Católica de ChileSantiago Chile
- Institute for Biological and Medical EngineeringSchools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de ChileSantiago Chile
| | - Israel Valverde
- Hospital Virgen del RocioUniversidad de SevillaSeville Spain
- Institute of Biomedicine of SevilleUniversidad de SevillaSeville Spain
| | - Sergio Uribe
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of RadiologySchool of Medicine, Pontificia Universidad Católica de ChileSantiago Chile
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Busch J, Giese D, Kozerke S. Image-based background phase error correction in 4D flow MRI revisited. J Magn Reson Imaging 2017; 46:1516-1525. [PMID: 28225577 DOI: 10.1002/jmri.25668] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/26/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- Julia Busch
- Institute for Biomedical Engineering; University of Zurich and ETH Zurich; Zurich Switzerland
| | - Daniel Giese
- Department of Radiology; University Hospital Cologne; Cologne Germany
| | - Sebastian Kozerke
- Institute for Biomedical Engineering; University of Zurich and ETH Zurich; Zurich Switzerland
- Division of Imaging Science and Biomedical Engineering; King's College London; London UK
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Update on the Role of Cardiac Magnetic Resonance Imaging in Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:2. [PMID: 28144782 DOI: 10.1007/s11936-017-0504-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OPINION STATEMENT Cardiac magnetic resonance imaging (CMR) is an important imaging modality in the evaluation of congenital heart diseases (CHD). CMR has several strengths including good spatial and temporal resolutions, wide field-of-view, and multi-planar imaging capabilities. CMR provides significant advantages for imaging in CHD through its ability to measure function, flow and vessel sizes, create three-dimensional reconstructions, and perform tissue characterization, all in a single imaging study. Thus, CMR is the most comprehensive imaging modality available today for the evaluation of CHD. Newer MRI sequences and post-processing tools will allow further development of quantitative methods of analysis, and opens the door for risk stratification in CHD. CMR also can interface with computer modeling, 3D printing, and other methods of understanding the complex anatomic and physiologic relationships in CHD.
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Qualitative grading of aortic regurgitation: a pilot study comparing CMR 4D flow and echocardiography. Int J Cardiovasc Imaging 2016; 32:301-307. [PMID: 26498478 PMCID: PMC4737795 DOI: 10.1007/s10554-015-0779-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/25/2015] [Indexed: 11/21/2022]
Abstract
Over the past 10 years there has been intense research in the development of volumetric visualization of intracardiac flow by cardiac magnetic resonance (CMR). This volumetric time resolved technique called CMR 4D flow imaging has several advantages over standard CMR. It offers anatomical, functional and flow information in a single free-breathing, ten-minute acquisition. However, the data obtained is large and its processing requires dedicated software. We evaluated a cloud-based application package that combines volumetric data correction and visualization of CMR 4D flow data, and assessed its accuracy for the detection and grading of aortic valve regurgitation using transthoracic echocardiography as reference. Between June 2014 and January 2015, patients planned for clinical CMR were consecutively approached to undergo the supplementary CMR 4D flow acquisition. Fifty four patients (median age 39 years, 32 males) were included. Detection and grading of the aortic valve regurgitation using CMR 4D flow imaging were evaluated against transthoracic echocardiography. The agreement between 4D flow CMR and transthoracic echocardiography for grading of aortic valve regurgitation was good (κ = 0.73). To identify relevant, more than mild aortic valve regurgitation, CMR 4D flow imaging had a sensitivity of 100 % and specificity of 98 %. Aortic regurgitation can be well visualized, in a similar manner as transthoracic echocardiography, when using CMR 4D flow imaging.
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Owen JW, Raptis CA. Emerging Clinical Applications of 4D Flow MR in the Heart and Aorta. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kamphuis VP, Westenberg JJM, van der Palen RLF, Blom NA, de Roos A, van der Geest R, Elbaz MSM, Roest AAW. Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance. Int J Cardiovasc Imaging 2016; 33:1069-1081. [PMID: 27888419 PMCID: PMC5489572 DOI: 10.1007/s10554-016-1031-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
Abstract
Knowledge of normal and abnormal flow patterns in the human cardiovascular system increases our understanding of normal physiology and may help unravel the complex pathophysiological mechanisms leading to cardiovascular disease. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has emerged as a suitable technique that enables visualization of in vivo blood flow patterns and quantification of parameters that could potentially be of prognostic value in the disease process. In this review, current image processing tools that are used for comprehensive visualization and quantification of blood flow and energy distribution in the heart and great vessels will be discussed. Also, imaging biomarkers extracted from 4D flow CMR will be reviewed that have been shown to distinguish between normal and abnormal flow patterns. Furthermore, current applications of 4D flow CMR in the heart and great vessels will be discussed, showing its potential as an additional diagnostic modality which could aid in disease management and timing of surgical intervention.
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Affiliation(s)
- Vivian P Kamphuis
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammed S M Elbaz
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Kolipaka A, Illapani VSP, Kalra P, Garcia J, Mo X, Markl M, White RD. Quantification and comparison of 4D-flow MRI-derived wall shear stress and MRE-derived wall stiffness of the abdominal aorta. J Magn Reson Imaging 2016; 45:771-778. [PMID: 27603433 DOI: 10.1002/jmri.25445] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/10/2016] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Aortic wall shear stress (WSSFlow ) alters endothelial function, which in-turn changes aortic wall stiffness leading to remodeling in different disease states. Therefore, the aims of this study are to determine normal physiologic correlations between: (1) Magnetic Resonance Elastography (MRE)-derived aortic wall stiffness (WSMRE ) and WSSFlow ; (2) WSMRE and mean velocity; (3) WSMRE and pulse wave velocity (PWV);( 4) WSMRE and mean peak flow; and (5) WSMRE , WSSFlow and age using MRE and 4D-flow MRI in the abdominal aorta in healthy human subjects. MATERIALS AND METHODS Cardiac-gated aortic MRE and 4D-flow MRI data were acquired in 24 healthy volunteers using a 3 Tesla scanner. For MRE, 70 Hz external motion was applied to obtain wave images in all spatial directions in a separate breathhold. Whereas, 4D-flow data was acquired under free-breathing. Wave images in all the directions were processed to obtain three-dimensional-weighted stiffness map at end-systole (ES). WSSFlow , mean velocity, PWV and mean peak flow were obtained using 4D-flow data. Pearson correlation was performed to determine association between all variables. RESULTS A significant negative correlation was observed between: (1) ES WSMRE and WSSFlow in both axial (r = -0.62; P = 0.006) and circumferential (r = -0.52; P = 0.016) directions; (2) ES WSMRE and mean velocity (r = -0.58; P = 0.012); and (3) age and WSSFlow in both axial (r = -0.71; P < 0.0001) and circumferential (r = -0.58; P = 0.0012) directions. A significant positive correlation was observed between: (1) ES WSMRE and PWV (r = 0.69; P < 0.0001); (2) ES WSMRE and mean peak flow (r = 0.53; P = 0.016); and (3) ES WSMRE and age (r = 0.63;P = 0.006). CONCLUSION The negative significant correlation between aortic WSSFlow and WSMRE in normal volunteers demonstrates a relationship between WSMRE and WSSFlow . LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:771-778.
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Affiliation(s)
- Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Internal Medicine-Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Venkata Sita Priyanka Illapani
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Prateek Kalra
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julio Garcia
- Department of Radiology, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA
| | - Xiaokui Mo
- Center for Biostatistics, Department of Biomedical Informatics, Columbus, Ohio, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.,Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
| | - Richard D White
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Internal Medicine-Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Wendell DC, Samyn MM, Cava JR, Krolikowski MM, LaDisa JF. The Impact of Cardiac Motion on Aortic Valve Flow Used in Computational Simulations of the Thoracic Aorta. J Biomech Eng 2016; 138:2531718. [PMID: 27367143 DOI: 10.1115/1.4033964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Indexed: 02/04/2023]
Abstract
Advancements in image-based computational modeling are producing increasingly more realistic representations of vasculature and hemodynamics, but so far have not compensated for cardiac motion when imposing inflow boundary conditions. The effect of cardiac motion on aortic flow is important when assessing sequelae in this region including coarctation of the aorta (CoA) or regurgitant fraction. The objective of this investigation was to develop a method to assess and correct for the influence of cardiac motion on blood flow measurements through the aortic valve (AoV) and to determine its impact on patient-specific local hemodynamics quantified by computational fluid dynamics (CFD). A motion-compensated inflow waveform was imposed into the CFD model of a patient with repaired CoA that accounted for the distance traveled by the basal plane during the cardiac cycle. Time-averaged wall shear stress (TAWSS) and turbulent kinetic energy (TKE) values were compared with CFD results of the same patient using the original waveform. Cardiac motion resulted in underestimation of flow during systole and overestimation during diastole. Influences of inflow waveforms on TAWSS were greatest along the outer wall of the ascending aorta (AscAo) (∼30 dyn/cm2). Differences in TAWSS were more pronounced than those from the model creation or mesh dependence aspects of CFD. TKE was slightly higher for the motion-compensated waveform throughout the aortic arch. These results suggest that accounting for cardiac motion when quantifying blood flow through the AoV can lead to different conclusions for hemodynamic indices, which may be important if these results are ultimately used to predict patient outcomes.
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