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Dirix P, Buoso S, Kozerke S. Optimizing encoding strategies for 4D Flow MRI of mean and turbulent flow. Sci Rep 2024; 14:19897. [PMID: 39191846 DOI: 10.1038/s41598-024-70449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
For 4D Flow MRI of mean and turbulent flow a compromise between spatiotemporal undersampling and velocity encodings needs to be found. Assuming a fixed scan time budget, the impact of trading off spatiotemporal undersampling versus velocity encodings on quantification of velocity and turbulence for aortic 4D Flow MRI was investigated. For this purpose, patient-specific mean and turbulent aortic flow data were generated using computational fluid dynamics which were embedded into the patient-specific background image data to generate synthetic MRI data with corresponding ground truth flow. Cardiac and respiratory motion were included. Using the synthetic MRI data as input, 4D Flow MRI was subsequently simulated with undersampling along pseudo-spiral Golden angle Cartesian trajectories for various velocity encoding schemes. Data were reconstructed using a locally low rank approach to obtain mean and turbulent flow fields to be compared to ground truth. Results show that, for a 15-min scan, velocity magnitudes can be reconstructed with good accuracy relatively independent of the velocity encoding scheme ( S S I M U = 0.938 ± 0.003 ) , good accuracy ( S S I M U ≥ 0.933 ) and with peak velocity errors limited to 10%. Turbulence maps on the other hand suffer from both lower reconstruction quality ( S S I M TKE ≥ 0.323 ) and larger sensitivity to undersampling, motion and velocity encoding strengths ( S S I M TKE = 0.570 ± 0.110 ) when compared to velocity maps. The best compromise to measure unwrapped velocity maps and turbulent kinetic energy given a fixed 15-min scan budget was found to be a 7-point multi- V enc acquisition with a low V enc tuned for best sensitivity to the range of expected intra-voxel standard deviations and a high V enc larger than the expected peak velocity.
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Affiliation(s)
- Pietro Dirix
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
| | - Stefano Buoso
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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Manini C, Hüllebrand M, Walczak L, Nordmeyer S, Jarmatz L, Kuehne T, Stern H, Meierhofer C, Harloff A, Erley J, Kelle S, Bannas P, Trauzeddel RF, Schulz-Menger J, Hennemuth A. Impact of training data composition on the generalizability of convolutional neural network aortic cross-section segmentation in four-dimensional magnetic resonance flow imaging. J Cardiovasc Magn Reson 2024; 26:101081. [PMID: 39127260 DOI: 10.1016/j.jocmr.2024.101081] [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: 11/27/2023] [Revised: 07/08/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Four-dimensional cardiovascular magnetic resonance flow imaging (4D flow CMR) plays an important role in assessing cardiovascular diseases. However, the manual or semi-automatic segmentation of aortic vessel boundaries in 4D flow data introduces variability and limits the reproducibility of aortic hemodynamics visualization and quantitative flow-related parameter computation. This paper explores the potential of deep learning to improve 4D flow CMR segmentation by developing models for automatic segmentation and analyzes the impact of the training data on the generalization of the model across different sites, scanner vendors, sequences, and pathologies. METHODS The study population consists of 260 4D flow CMR datasets, including subjects without known aortic pathology, healthy volunteers, and patients with bicuspid aortic valve (BAV) examined at different hospitals. The dataset was split to train segmentation models on subsets with different representations of characteristics, such as pathology, gender, age, scanner model, vendor, and field strength. An enhanced three-dimensional U-net convolutional neural network (CNN) architecture with residual units was trained for time-resolved two-dimensional aortic cross-sectional segmentation. Model performance was evaluated using Dice score, Hausdorff distance, and average symmetric surface distance on test data, datasets with characteristics not represented in the training set (model-specific), and an overall evaluation set. Standard diagnostic flow parameters were computed and compared with manual segmentation results using Bland-Altman analysis and interclass correlation. RESULTS The representation of technical factors, such as scanner vendor and field strength, in the training dataset had the strongest influence on the overall segmentation performance. Age had a greater impact than gender. Models solely trained on BAV patients' datasets performed well on datasets of healthy subjects but not vice versa. CONCLUSION This study highlights the importance of considering a heterogeneous dataset for the training of widely applicable automatic CNN segmentations in 4D flow CMR, with a particular focus on the inclusion of different pathologies and technical aspects of data acquisition.
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Affiliation(s)
- Chiara Manini
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
| | - Markus Hüllebrand
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; Fraunhofer MEVIS, Berlin, Germany
| | - Lars Walczak
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; Fraunhofer MEVIS, Berlin, Germany
| | - Sarah Nordmeyer
- Department of Diagnostic and Interventional Radiology, Tübingen University Hospital, Tübingen, Germany
| | - Lina Jarmatz
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
| | - Titus Kuehne
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, University Medical Center Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jennifer Erley
- German Center for Cardiovascular Research (DZHK), Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Sebastian Kelle
- German Center for Cardiovascular Research (DZHK), Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Felix Trauzeddel
- German Center for Cardiovascular Research (DZHK), Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Jeanette Schulz-Menger
- German Center for Cardiovascular Research (DZHK), Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125 Berlin, Germany; Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité - Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; Department of Cardiology and Nephrology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Anja Hennemuth
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; Fraunhofer MEVIS, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Fischer K, Grob L, Setz L, Jung B, Neuenschwander MD, Utz CD, von Tengg-Kobligk H, Huber AT, Friess JO, Guensch DP. Direct comparison of whole heart quantifications between different retrospective and prospective gated 4D flow CMR acquisitions. Front Cardiovasc Med 2024; 11:1411752. [PMID: 39145279 PMCID: PMC11322094 DOI: 10.3389/fcvm.2024.1411752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/18/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction 4D flow cardiovascular magnetic resonance (CMR) is a versatile technique to non-invasively assess cardiovascular hemodynamics. With developing technology, choice in sequences and acquisition parameters is expanding and it is important to assess if data acquired with these different variants can be directly compared, especially when combining datasets within research studies. For example, sequences may allow a choice in gating techniques or be limited to one method, yet there is not a direct comparison investigating how gating selection impacts quantifications of the great vessels, semilunar and atrioventricular valves and ventricles. Thus, this study investigated if quantifications across the heart from contemporary 4D flow sequences are comparable between two commonly used 4D flow sequences reliant on different ECG gating techniques. Methods Forty participants (33 healthy controls, seven patients with coronary artery disease and abnormal diastolic function) were prospectively recruited into a single-centre observational study to undergo a 3T-CMR exam. Two acquisitions, a k-t GRAPPA 4D flow with prospective gating (4Dprosp) and a modern compressed sensing 4D flow with retrospective gating (4Dretro), were acquired in each participant. Images were analyzed for volumes, flow rates and velocities in the vessels and four valves, and for biventricular kinetic energy and flow components. Data was compared for group differences with paired t-tests and for agreement with Bland-Altman and intraclass correlation (ICC). Results Measurements primarily occurring during systole of the great vessels, semilunar valves and both left and right ventricles did not differ between acquisition types (p > 0.05 from t-test) and yielded good to excellent agreement (ICC: 0.75-0.99). Similar findings were observed for the majority of parameters dependent on early diastole. However, measurements occurring in late diastole or those reliant on the entire-cardiac cycle such as flow component volumes along with diastolic kinetic energy values were not similar between 4Dprosp and 4Dretro acquisitions resulting in poor agreement (ICC < 0.50). Discussion Direct comparison of measurements between two different 4D flow acquisitions reliant on different gating methods demonstrated systolic and early diastolic markers across the heart should be compatible when comparing these two 4D flow sequences. On the other hand, late diastolic and intraventricular parameters should be compared with caution.
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Affiliation(s)
- Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leonard Grob
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Louis Setz
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Sitem-Insel, Bern, Switzerland
| | - Mario D. Neuenschwander
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph D. Utz
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Sitem-Insel, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Jan O. Friess
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik P. Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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4
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Yurpolskaya LA. [4D flow MRI: value and clinical perspectives in patients with pathology of the heart and great vessels (part 2): A review]. TERAPEVT ARKH 2024; 96:701-705. [PMID: 39106514 DOI: 10.26442/00403660.2024.07.202786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/16/2024] [Indexed: 08/09/2024]
Abstract
The study of blood flow is becoming a new trend in cardiology and cardiovascular surgery. Based on the literature and our own data, a review is presented on the use of 4D flow in diseases of the heart and blood vessels. The main state of the question about the features of the application of the technique in various pathologies of the cardiovascular system is described in detail, the priorities, limitations and promising directions of the technique application are considered taking into account the goals of practical medicine. The review consists of two parts. The first is devoted to general issues, limitations of the technique, and issues of 4D flow mapping in patients with lesions of the great vessels. In the second part, the emphasis is on the use of 4D flow MRI in the study of intraventricular blood flow and the application of the technique in congenital heart and vascular diseases.
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Affiliation(s)
- L A Yurpolskaya
- Bakulev National Medical Research Center for Cardiovascular Surgery
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5
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Ramaekers MJFG, Westenberg JJM, Adriaans BP, Nijssen EC, Wildberger JE, Lamb HJ, Schalla S. A clinician's guide to understanding aortic 4D flow MRI. Insights Imaging 2023; 14:114. [PMID: 37395817 DOI: 10.1186/s13244-023-01458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
Four-dimensional flow magnetic resonance imaging is an emerging technique which may play a role in diagnosis and risk-stratification of aortic disease. Some knowledge of flow dynamics and related parameters is necessary to understand and apply this technique in clinical workflows. The purpose of the current review is to provide a guide for clinicians to the basics of flow imaging, frequently used flow-related parameters, and their relevance in the context of aortic disease.Clinical relevance statement Understanding normal and abnormal aortic flow could improve clinical care in patients with aortic disease.
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Affiliation(s)
- Mitch J F G Ramaekers
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bouke P Adriaans
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Estelle C Nijssen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Shaffer A, Nigh N, Weisbaum D, Anderson A, Wszalek T, Sutton BP, Webb A, Damon B, Moussa I, Arnold PM. Cardiothoracic and Vascular Surgery Implant Compatibility With Ultrahigh Field Magnetic Resonance Imaging (4.7 Tesla and 7 Tesla). Am J Cardiol 2023; 201:239-246. [PMID: 37392607 DOI: 10.1016/j.amjcard.2023.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/03/2023]
Abstract
The use of 7 Tesla (T) magnetic resonance imaging (MRI) is expanding across medical specialties, particularly, clinical neurosciences and orthopedics. Investigational 7 T MRI has also been performed in cardiology. A limiting factor for expansion of the role of 7 T, irrespective of the body part being imaged, is the sparse testing of biomedical implant compatibility at field strengths >3 T. Implant compatibility can be tested following the American Society for Testing and Materials International guidelines. To assess the current state of cardiovascular implant safety at field strengths >3 T, a systematic search was performed using PubMed, Web of Science, and citation matching. Studies written in English that included at least 1 cardiovascular-related implant and at least 1 safety outcome (deflection angle, torque, or temperature change) were included. Data were extracted for the implant studied, implant composition, deflection angle, torque, and temperature change, and the American Society for Testing and Materials International standards were followed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines for scoping reviews were followed. A total of 9 studies were included. A total of 34 cardiovascular-related implants tested ex vivo at 7 T and 91 implants tested ex vivo at 4.7 T were included. The implants included vascular grafts and conduits, vascular access ports, peripheral and coronary stents, caval filters, and artificial valves. A total of 2 grafts, 1 vascular access port, 2 vena cava filters, and 5 stents were identified as incompatible with the 7 T MRI. All incompatible stents were 40 mm in length. Based on the safety outcomes reported, we identify several implants that may be compatible with >3 T MRI. This scoping review seeks to concisely summarize all the cardiovascular-related implants tested for ultrahigh field MRI compatibility to date.
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Affiliation(s)
- Annabelle Shaffer
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois
| | - Noah Nigh
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois
| | - David Weisbaum
- Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois
| | - Aaron Anderson
- Carle Illinois Advanced Imaging Center, Carle Foundation Hospital, Urbana, Illinois; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tracey Wszalek
- Carle Illinois Advanced Imaging Center, Carle Foundation Hospital, Urbana, Illinois; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bradley P Sutton
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; Carle Illinois Advanced Imaging Center, Carle Foundation Hospital, Urbana, Illinois; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew Webb
- Carle Illinois Advanced Imaging Center, Carle Foundation Hospital, Urbana, Illinois; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - Bruce Damon
- Carle Illinois Advanced Imaging Center, Carle Foundation Hospital, Urbana, Illinois; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Issam Moussa
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; Heart and Vascular Institute, Carle Foundation Hospital, Urbana, Illinois
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Urbana, Illinois; Department of Neurosurgery, Carle Foundation Hospital, Urbana, Illinois.
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Sache A, Reymond P, Brina O, Jung B, Farhat M, Vargas MI. Near-wall hemodynamic parameters quantification in in vitro intracranial aneurysms with 7 T PC-MRI. MAGMA (NEW YORK, N.Y.) 2023; 36:295-308. [PMID: 37072539 PMCID: PMC10140017 DOI: 10.1007/s10334-023-01082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Wall shear stress (WSS) and its derived spatiotemporal parameters have proven to play a major role on intracranial aneurysms (IAs) growth and rupture. This study aims to demonstrate how ultra-high field (UHF) 7 T phase contrast magnetic resonance imaging (PC-MRI) coupled with advanced image acceleration techniques allows a highly resolved visualization of near-wall hemodynamic parameters patterns in in vitro IAs, paving the way for more robust risk assessment of their growth and rupture. MATERIALS AND METHODS We performed pulsatile flow measurements inside three in vitro models of patient-specific IAs using 7 T PC-MRI. To this end, we built an MRI-compatible test bench, which faithfully reproduced a typical physiological intracranial flow rate in the models. RESULTS The ultra-high field 7 T images revealed WSS patterns with high spatiotemporal resolution. Interestingly, the high oscillatory shear index values were found in the core of low WSS vortical structures and in flow stream intersecting regions. In contrast, maxima of WSS occurred around the impinging jet sites. CONCLUSIONS We showed that the elevated signal-to-noise ratio arising from 7 T PC-MRI enabled to resolve high and low WSS patterns with a high degree of detail.
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Affiliation(s)
- Antoine Sache
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Farhat
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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8
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Nurzed B, Kuehne A, Aigner CS, Schmitter S, Niendorf T, Eigentler TW. Radiofrequency antenna concepts for human cardiac MR at 14.0 T. MAGMA (NEW YORK, N.Y.) 2023; 36:257-277. [PMID: 36920549 PMCID: PMC10140016 DOI: 10.1007/s10334-023-01075-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To examine the feasibility of human cardiac MR (CMR) at 14.0 T using high-density radiofrequency (RF) dipole transceiver arrays in conjunction with static and dynamic parallel transmission (pTx). MATERIALS AND METHODS RF arrays comprised of self-grounded bow-tie (SGBT) antennas, bow-tie (BT) antennas, or fractionated dipole (FD) antennas were used in this simulation study. Static and dynamic pTx were applied to enhance transmission field (B1+) uniformity and efficiency in the heart of the human voxel model. B1+ distribution and maximum specific absorption rate averaged over 10 g tissue (SAR10g) were examined at 7.0 T and 14.0 T. RESULTS At 14.0 T static pTx revealed a minimum B1+ROI efficiency of 0.91 μT/√kW (SGBT), 0.73 μT/√kW (BT), and 0.56 μT/√kW (FD) and maximum SAR10g of 4.24 W/kg, 1.45 W/kg, and 2.04 W/kg. Dynamic pTx with 8 kT points indicate a balance between B1+ROI homogeneity (coefficient of variation < 14%) and efficiency (minimum B1+ROI > 1.11 µT/√kW) at 14.0 T with a maximum SAR10g < 5.25 W/kg. DISCUSSION MRI of the human heart at 14.0 T is feasible from an electrodynamic and theoretical standpoint, provided that multi-channel high-density antennas are arranged accordingly. These findings provide a technical foundation for further explorations into CMR at 14.0 T.
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Affiliation(s)
- Bilguun Nurzed
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), Robert Rössle Strasse 10, 13125, Berlin, Germany
| | | | | | | | - Thoralf Niendorf
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), Robert Rössle Strasse 10, 13125, Berlin, Germany.
- MRI.TOOLS GmbH, Berlin, Germany.
- Experimental and Clinical Research Center (ECRC), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
| | - Thomas Wilhelm Eigentler
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), Robert Rössle Strasse 10, 13125, Berlin, Germany
- Chair of Medical Engineering, Technische Universität Berlin, Berlin, Germany
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9
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Dirix P, Buoso S, Peper ES, Kozerke S. Synthesis of patient-specific multipoint 4D flow MRI data of turbulent aortic flow downstream of stenotic valves. Sci Rep 2022; 12:16004. [PMID: 36163357 PMCID: PMC9513106 DOI: 10.1038/s41598-022-20121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
We propose to synthesize patient-specific 4D flow MRI datasets of turbulent flow paired with ground truth flow data to support training of inference methods. Turbulent blood flow is computed based on the Navier-Stokes equations with moving domains using realistic boundary conditions for aortic shapes, wall displacements and inlet velocities obtained from patient data. From the simulated flow, synthetic multipoint 4D flow MRI data is generated with user-defined spatiotemporal resolutions and reconstructed with a Bayesian approach to compute time-varying velocity and turbulence maps. For MRI data synthesis, a fixed hypothetical scan time budget is assumed and accordingly, changes to spatial resolution and time averaging result in corresponding scaling of signal-to-noise ratios (SNR). In this work, we focused on aortic stenotic flow and quantification of turbulent kinetic energy (TKE). Our results show that for spatial resolutions of 1.5 and 2.5 mm and time averaging of 5 ms as encountered in 4D flow MRI in practice, peak total turbulent kinetic energy downstream of a 50, 75 and 90% stenosis is overestimated by as much as 23, 15 and 14% (1.5 mm) and 38, 24 and 23% (2.5 mm), demonstrating the importance of paired ground truth and 4D flow MRI data for assessing accuracy and precision of turbulent flow inference using 4D flow MRI exams.
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Affiliation(s)
- Pietro Dirix
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
| | - Stefano Buoso
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Eva S Peper
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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10
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Isoda H, Fukuyama A. Quality Control for 4D Flow MR Imaging. Magn Reson Med Sci 2022; 21:278-292. [PMID: 35197395 PMCID: PMC9680545 DOI: 10.2463/mrms.rev.2021-0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 01/06/2023] Open
Abstract
In recent years, 4D flow MRI has become increasingly important in clinical applications for the blood vessels in the whole body, heart, and cerebrospinal fluid. 4D flow MRI has advantages over 2D cine phase-contrast (PC) MRI in that any targeted area of interest can be analyzed post-hoc, but there are some factors to be considered, such as ensuring measurement accuracy, a long imaging time and post-processing complexity, and interobserver variability.Due to the partial volume phenomenon caused by low spatial and temporal resolutions, the accuracy of flow measurement in 4D flow MRI is reduced. For spatial resolution, it is recommended to include at least four voxels in the vessel of interest, and if possible, six voxels. In large vessels such as the aorta, large voxels can be secured and SNR can be maintained, but in small cerebral vessels, SNR is reduced, resulting in reduced accuracy. A temporal resolution of less than 40 ms is recommended. The velocity-to-noise ratio (VNR) of low-velocity blood flow is low, resulting in poor measurement accuracy. The use of dual velocity encoding (VENC) or multi-VENC is recommended to avoid velocity wrap around and to increase VNR. In order to maintain sufficient spatio-temporal resolution, a longer imaging time is required, leading to potential patient movement during examination and a corresponding decrease in measurement accuracy.For the clinical application of new technologies, including various acceleration techniques, in vitro and in vivo accuracy verification based on existing accuracy-validated 2D cine PC MRI and 4D flow MRI, as well as accuracy verification on the conservation of mass' principle, should be performed, and intraobserver repeatability, interobserver reproducibility, and test-retest reproducibility should be checked.
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Affiliation(s)
- Haruo Isoda
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Biomedical Imaging Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Atsushi Fukuyama
- Faculty of Health Sciences, Department of Radiological Sciences, Japan Healthcare University, Sapporo, Hokkaido, Japan
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11
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Minderhoud SCS, Roos-Hesselink JW, Chelu RG, Bons LR, van den Hoven AT, Korteland SA, van den Bosch AE, Budde RPJ, Wentzel JJ, Hirsch A. Wall shear stress angle is associated with aortic growth in bicuspid aortic valve patients. Eur Heart J Cardiovasc Imaging 2022; 23:1680-1689. [PMID: 34977931 DOI: 10.1093/ehjci/jeab290] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/18/2021] [Indexed: 02/01/2023] Open
Abstract
AIMS Aortic wall shear stress (WSS) distributions in bicuspid aortic valve (BAV) patients have been associated with aortic dilatation, but prospective, longitudinal data are missing. This study assessed differences in aortic WSS distributions between BAV patients and healthy controls and determined the association of WSS with aortic growth in patients. METHODS AND RESULTS Sixty subjects underwent four-dimensional (4D) flow cardiovascular magnetic resonance of the thoracic aorta (32 BAV patients and 28 healthy controls). Peak velocity, pulse wave velocity, aortic distensibility, peak systolic WSS (magnitude, axial, and circumferential), and WSS angle were assessed. WSS angle is defined as the angle between the WSSmagnitude and WSSaxial component. In BAV patients, three-year computed tomography angiography-based aortic volumetric growth was determined in the proximal and entire ascending aorta. WSSaxial was significantly lower in BAV patients compared with controls (0.93 vs. 0.72 Pa, P = 0.047) and WSScircumferential and WSS angle were significantly higher (0.29 vs. 0.64 Pa and 18° vs. 40°, both P < 0.001). Significant volumetric growth of the proximal ascending aorta occurred in BAV patients (from 49.1 to 52.5 cm3, P = 0.003). In multivariable analysis corrected for baseline aortic volume and diastolic blood pressure, WSS angle was the only parameter independently associated with proximal aortic growth (P = 0.031). In the entire ascending aorta, besides the WSS angle, the WSSmagnitude was also independently associated with growth. CONCLUSION Increased WSScircumferential and especially WSS angle are typical in BAV patients. WSS angle was found to predict aortic growth. These findings highlight the potential role of WSS measurements in BAV patients to stratify patients at risk for aortic dilation.
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Affiliation(s)
- Savine C S Minderhoud
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Raluca G Chelu
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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12
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Holtackers RJ, Wildberger JE, Wintersperger BJ, Chiribiri A. Impact of Field Strength in Clinical Cardiac Magnetic Resonance Imaging. Invest Radiol 2021; 56:764-772. [PMID: 34261084 DOI: 10.1097/rli.0000000000000809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACT Cardiac magnetic resonance imaging (MRI) is widely applied for the noninvasive assessment of cardiac structure and function, and for tissue characterization. For more than 2 decades, 1.5 T has been considered the field strength of choice for cardiac MRI. Although the number of 3-T systems significantly increased in the past 10 years and numerous new developments were made, challenges seem to remain that hamper a widespread clinical use of 3-T MR systems for cardiac applications. As the number of clinical cardiac applications is increasing, with each having their own benefits at both field strengths, no "holy grail" field strength exists for cardiac MRI that one should ideally use. This review describes the physical differences between 1.5 and 3 T, as well as the effect of these differences on major (routine) cardiac MRI applications, including functional imaging, edema imaging, late gadolinium enhancement, first-pass stress perfusion, myocardial mapping, and phase contrast flow imaging. For each application, the advantages and limitations at both 1.5 and 3 T are discussed. Solutions and alternatives are provided to overcome potential limitations. Finally, we briefly elaborate on the potential use of alternative field strengths (ie, below 1.5 T and above 3 T) for cardiac MRI and conclude with field strength recommendations for the future of cardiac MRI.
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13
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Seyedpour SM, Nabati M, Lambers L, Nafisi S, Tautenhahn HM, Sack I, Reichenbach JR, Ricken T. Application of Magnetic Resonance Imaging in Liver Biomechanics: A Systematic Review. Front Physiol 2021; 12:733393. [PMID: 34630152 PMCID: PMC8493836 DOI: 10.3389/fphys.2021.733393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022] Open
Abstract
MRI-based biomechanical studies can provide a deep understanding of the mechanisms governing liver function, its mechanical performance but also liver diseases. In addition, comprehensive modeling of the liver can help improve liver disease treatment. Furthermore, such studies demonstrate the beginning of an engineering-level approach to how the liver disease affects material properties and liver function. Aimed at researchers in the field of MRI-based liver simulation, research articles pertinent to MRI-based liver modeling were identified, reviewed, and summarized systematically. Various MRI applications for liver biomechanics are highlighted, and the limitations of different viscoelastic models used in magnetic resonance elastography are addressed. The clinical application of the simulations and the diseases studied are also discussed. Based on the developed questionnaire, the papers' quality was assessed, and of the 46 reviewed papers, 32 papers were determined to be of high-quality. Due to the lack of the suitable material models for different liver diseases studied by magnetic resonance elastography, researchers may consider the effect of liver diseases on constitutive models. In the future, research groups may incorporate various aspects of machine learning (ML) into constitutive models and MRI data extraction to further refine the study methodology. Moreover, researchers should strive for further reproducibility and rigorous model validation and verification.
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Affiliation(s)
- Seyed M. Seyedpour
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Mehdi Nabati
- Department of Mechanical Engineering, Faculty of Engineering, Boğaziçi University, Istanbul, Turkey
| | - Lena Lambers
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Sara Nafisi
- Faculty of Pharmacy, Istinye University, Istanbul, Turkey
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
- Center of Medical Optics and Photonics, Friedrich Schiller University, Jena, Germany
- Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University, Jena, Germany
| | - Tim Ricken
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
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14
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Schuster A, Thiele H, Katus H, Werdan K, Eitel I, Zeiher AM, Baldus S, Rolf A, Kelle S. Kompetenz und Innovation in der kardiovaskulären MRT: Stellungnahme der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung. DER KARDIOLOGE 2021. [PMCID: PMC8361824 DOI: 10.1007/s12181-021-00494-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diese Stellungnahme der Deutschen Gesellschaft für Kardiologie (DGK) beschäftigt sich mit der Bedeutung kardiologischer Kompetenz im Gebiet der kardiovaskulären Magnetresonanztomographie (CMR) und deren Aus- und Wechselwirkungen auf klinisches Management im Bereich der Diagnostik, Therapieplanung und Therapie von kardiologischen Patienten. Zahlreiche Innovationen sowohl im technischen als auch klinischen Bereich der CMR basieren auf Publikationen deutscher und europäischer Kardiologen und haben Einzug in die nationalen, europäischen und auch US-amerikanischen Leitlinien gefunden. Hier sollen Empfehlungen zur sicheren, qualitativ hochwertigen und kompetenten Durchführung von CMR-Untersuchungen gegeben werden, im Sinne einer optimalen Nutzung dieser Technik mit unmittelbarer klinischer Einordnung des Untersuchungsergebnisses für die Planung einer Therapiestrategie des kardiovaskulär erkrankten Patienten.
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Affiliation(s)
- Andreas Schuster
- Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Deutschland
- Partner Site Göttingen, Deutsches Zentrum für Herz-Kreislauf-Forschung, Göttingen, Deutschland
| | - Holger Thiele
- Herzzentrum Leipzig, Klinik für Innere Medizin und Kardiologie, Universität Leipzig, Leipzig, Deutschland
- Leipzig Heart Science gGmbH, Leipzig, Deutschland
| | - Hugo Katus
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Karl Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Ingo Eitel
- Medizinische Klinik II – Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Stephan Baldus
- Medizinische Klinik III – Abteilung für Kardiologie, Pneumologie, Angiologie und Intensivmedizin, Universität Köln, Köln, Deutschland
| | - Andreas Rolf
- Klinik für Kardiologie, Herz‑, Lungen‑, Gefäß- und Rheumazentrum, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - Sebastian Kelle
- Deutsches Herzzentrum Berlin, Berlin, Deutschland
- Klinik für Innere Medizin und Kardiologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Deutschland
- Partner Site Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Deutschland
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15
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Doyle CM, Orr J, Greenwood JP, Plein S, Tsoumpas C, Bissell MM. Four-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review. J Magn Reson Imaging 2021; 55:1301-1321. [PMID: 34416048 DOI: 10.1002/jmri.27874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Four-dimensional (4D) flow magnetic resonance imaging (MRI) allows multidirectional quantification of blood flow in the heart and great vessels. Comparability of the technique to the current reference standards of flow assessment-two-dimensional (2D) flow MRI and Doppler echocardiography-varies in the literature. Image acquisition parameters likely impact upon the accuracy and reproducibility of 4D flow MRI. We therefore sought to review the current literature on 4D flow MRI in the heart and great vessels, in comparison to 2D flow MRI, Doppler echocardiography, and invasive catheterization. Using a predefined search strategy and inclusion and exclusion criteria, the databases EMBASE and Medline were searched in January 2021 for peer-reviewed research articles comparing cardiac 4D flow MRI to 2D flow MRI, Doppler echocardiography and/or invasive catheterization. The data from all relevant articles were assimilated and analyzed using Mann-Whitney U and chi χ2 test. Forty-four manuscripts met the eligibility criteria and were included in the review. The review showed agreement of 4D flow MRI to the reference standard methods of flow assessment, particular in the measurement of peak velocity and stroke volume in 55% of manuscripts. The use of valve tracking significantly improves agreement between 4D flow MRI and the reference modalities (79% matching with the use of valve tracking vs. 50% without, P = 0.04). This review highlights that the impact of acquisition parameters on 4D flow MRI accuracy is multifactorial. It is therefore important that each center conducts its own quality assurance prior to using 4D flow MRI for clinical decision-making. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ciara M Doyle
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Jenny Orr
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - John P Greenwood
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
| | - Charalampos Tsoumpas
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK.,Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, UK
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16
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Demirkiran A, van Ooij P, Westenberg JJM, Hofman MBM, van Assen HC, Schoonmade LJ, Asim U, Blanken CPS, Nederveen AJ, van Rossum AC, Götte MJW. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Eur Heart J Cardiovasc Imaging 2021; 23:154-165. [PMID: 34143872 PMCID: PMC8787996 DOI: 10.1093/ehjci/jeab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Identification of flow patterns within the heart has long been recognized as a potential contribution to the understanding of physiological and pathophysiological processes of cardiovascular diseases. Although the pulsatile flow itself is multi-dimensional and multi-directional, current available non-invasive imaging modalities in clinical practice provide calculation of flow in only 1-direction and lack 3-dimensional volumetric velocity information. Four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) has emerged as a novel tool that enables comprehensive and critical assessment of flow through encoding velocity in all 3 directions in a volume of interest resolved over time. Following technical developments, 4D flow CMR is not only capable of visualization and quantification of conventional flow parameters such as mean/peak velocity and stroke volume but also provides new hemodynamic parameters such as kinetic energy. As a result, 4D flow CMR is being extensively exploited in clinical research aiming to improve understanding of the impact of cardiovascular disease on flow and vice versa. Of note, the analysis of 4D flow data is still complex and accurate analysis tools that deliver comparable quantification of 4D flow values are a necessity for a more widespread adoption in clinic. In this article, the acquisition and analysis processes are summarized and clinical applications of 4D flow CMR on the heart including conventional and novel hemodynamic parameters are discussed. Finally, clinical potential of other emerging intra-cardiac 4D flow imaging modalities is explored and a near-future perspective on 4D flow CMR is provided.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Usman Asim
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Carmen P S Blanken
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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