In Vitro Validation of Rapid MR Measurement of Wave Velocity

Group delay method for MRI aortic pulse wave velocity measurements in clinical protocols with low temporal resolution: Validation in a heterogeneous cohort

BACKGROUND

MRI assessment of aortic pulse wave velocity (PWV) helps predict the risk of vascular events, but the recommended phase contrast sampling rate is faster than what is utilized in most clinical sequences. There are many existing MRI databases obtained for assessment of cardiac output using lower temporal frequency sampling where information might be obtained about aortic stiffness (PWV). In this work, we sought to evaluate whether the Group Delay (GD) method can generate a reproducible measure of stiffness and describe expected age-related stiffening of the aortic arch using lower sampling rates in standard clinical sequences.

METHODS

Phase contrast (PC) MRI was obtained on the ascending and descending aortic arch in a heterogeneous adult cohort (n = 23; 9 women) spanning over a wide range of ages (ages 24-89, mean 49.4 ± 18.4). Data was collected with standard cardiac MRI protocols for cardiac output evaluation (repetition time = 7.8 ms, views-per-segment = 4, encoding velocity = 200 cm/s). Pulse wave transit times (TT) were computed using the GD method, two other validated automated approaches (cross correlation TT Algorithm by Gaddum and Segment by Medviso), and the manual tangent method. Pressure waveforms from tonometry and flow waveforms from PC MRI were used to assess wave reflections.

RESULTS

Group Delay and TT-Algorithm showed significant and high retest reproducibility (r = 0.86 for both) as well as high PWV correlation with age (r = 0.93, P-value < 0.00005 and r = 0.96, P-value < 0.00005 respectively) and with each other (r = 0.94, P-value < 0.00001, RMSE = 0.94 m/s). Arbitrary altering of the image acquisition trigger in the GD method introduced error of 10%-13%, but the TT-algorithm error range was 11%-25%.

CONCLUSION

Group Delay enables reproducible assessment of transit time to derive PWV from low temporal resolution clinical cardiac MRI sequences that can also identify age-related stiffening.

Computer-assisted evaluation of aortic stiffness using data acquired via magnetic resonance

Aortic stiffness is frequently assessed through pulse wave velocity (PWV) measurements. Based on data acquired by magnetic resonance (MR) using a one-dimensional time-of-flight technique, a new computational tool has been developed to rapidly construct flow velocity images and automatically calculate PWV. Comparison between PWV results obtained from this and a manual analysis demonstrates good agreement (correlation coefficient of 0.9951), while the new method improves the time efficiency by more than 20 times. The new method can also significantly improve flow signal quality and yield more credible results when strong interfering background signals are present.

Rapid measurement of pulse wave velocity via multisite flow displacement

A MR method is presented for measuring pulse wave velocity (PWV) and its application to assessing stiffness in the human thoracic aorta. This one-dimensional (1D) flow displacement method applies a single RF comb excitation to the vessel, followed by an oscillating frequency encoding gradient, each oscillation providing a 1D projection of the vessel, enabling one to track fluid motion. The currently implemented sequence excites nine slices within a 20-cm length of vessel and has a temporal resolution of 2.03 msec and a total acquisition time of 140 msec. Offline-reconstructed position-versus-time plots show curvilinear flow displacement trajectories corresponding to fluid motion at each of the excitation positions. The PWV can be reliably calculated by curve-fitting these trajectories to a model. In vitro studies using compliant tubes demonstrate no significant difference between results obtained using this method and those directly obtained using pressure transducers. Compared to another MR method previously developed in our laboratory, the proposed method displays improved temporal resolution and enhanced ability to extract PWV from vessels exhibiting low peak flow velocity. Preliminary data suggest that this method is feasible for in vivo application and may provide a more accurate estimation of aortic wave velocity among subjects exhibiting low peak flow velocity, such as the elderly or those with impaired cardiac function.

In vitro validation of MR measurements of arterial pulse-wave velocity in the presence of reflected waves

A magnetic resonance imaging projective velocity encoding sequence was used to determine the pulse-wave velocity in an artery model. To this end, a well-defined flow phantom simulating flow propagation in large arteries was used. In order to validate the measurement method in the presence of large reflected waves, these were deliberately created in the phantom. The projective sequence was applied to two measurement sites and the wave velocity was determined from the spatial and temporal separations of the foot of the velocity waveform. A theoretical model describing reflection and attenuation phenomena was compared with experimental velocity waveforms. The model showed that reflections and attenuation can explain the important changes in velocity waveforms. The model also confirmed that in the presence of reflecting waves, the foot of the waveform can be used as a characteristic point for measurements through changes in the waveform.

Rapid measurement of aortic wave velocity: in vivo evaluation

A 1D MR sequence has been developed for determining aortic flow wave velocity (WV), a metric of arterial compliance, within a single cardiac cycle. Studies were carried out on the thoracic aortas of 10 normal volunteers. Correlative WV data were also acquired from each subject using a conventional phase-velocity 2D mapping technique. Aortic WV in this cohort was found to range from 411 to 714 cm/s and was highly correlated (R = 0.95) between the two methods. Peak blood velocity was also measured using both methods and found to agree closely. The reproducibility of WV measurements using the rapid 1D method averaged 7.6%, which is comparable or better than that achieved using existing noninvasive techniques. Magn Reson Med 46:95-102, 2001.

Rapid aortic wave velocity measurement with MR imaging

The utility of a one-dimensional magnetic resonance (MR) sequence to rapidly and accurately measure wave velocity in vivo was evaluated. Studies were conducted in the thoracic aortas of 20 healthy subjects of varying age, and the MR method was validated in a compliant tube model. Aortic wave velocity ranged from 3.8 to 9.7 m/sec and demonstrated a positive correlation with subjects' age. Peak blood velocity ranged from 47 to 125 cm/sec and exhibited a strong negative correlation with subjects' age.

Estimation of aortic compliance using magnetic resonance pulse wave velocity measurement

A method for compliance estimation employing magnetic resonance pulse wave velocity measurement is presented. Time-resolved flow waves are recorded at several positions along the vessel using a phase contrast sequence, and pulse wave velocity is calculated from the delay of the wave onsets. Using retrospective cardiac gating in combination with an optically decoupled electrocardiogram acquisition, a high temporal resolution of 3 ms can be achieved. A phantom set-up for the simulation of pulsatile flow in a compliant vessel is described. In the phantom, relative errors of pulse wave velocity estimation were found to be about 15%, whereas in a volunteer, larger errors were found that might be caused by vessel branches. Results of pulse wave velocity estimation agree with direct aortic distension measurements which rely on a peripheral estimate of aortic pressure and are therefore less accurate. Studies in 12 volunteers show values of pulse wave velocity consistent with the literature; in particular the well-known increase in pulse wave velocity with age was observed. Preliminary results show that the method can be applied to aortic aneurysms.