1
|
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.
Collapse
Affiliation(s)
- L A Yurpolskaya
- Bakulev National Medical Research Center for Cardiovascular Surgery
| |
Collapse
|
2
|
McConnell B, Stoll VM, Panayiotou H, Piechnik SK, Neubauer S, van der Geest RJ, Myerson SG, Orchard E, Bissell MM. Acute vasodilator response testing in the adult Fontan circulation using non-invasive 4D Flow MRI: a proof-of-principle study. Cardiol Young 2023; 33:1342-1349. [PMID: 35942899 DOI: 10.1017/s1047951122002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pulmonary vasodilator therapy in Fontan patients can improve exercise tolerance. We aimed to assess the potential for non-invasive testing of acute vasodilator response using four-dimensional (D) flow MRI during oxygen inhalation. MATERIALS AND METHODS Six patients with well-functioning Fontan circulations were prospectively recruited and underwent cardiac MRI. Ventricular anatomical imaging and 4D Flow MRI were acquired at baseline and during inhalation of oxygen. Data were compared with six age-matched healthy volunteers with 4D Flow MRI scans acquired at baseline. RESULTS All six patients tolerated the MRI scan well. The dominant ventricle had a left ventricular morphology in all cases. On 4D Flow MRI assessment, two patients (Patients 2 and 6) showed improved cardiac filling with improved preload during oxygen administration, increased mitral inflow, increased maximum E-wave kinetic energy, and decreased systolic peak kinetic energy. Patient 1 showed improved preload only. Patient 5 showed no change, and patient 3 had equivocal results. Patient 4, however, showed a decrease in preload and cardiac filling/function with oxygen. DISCUSSION Using oxygen as a pulmonary vasodilator to assess increased pulmonary venous return as a marker for positive acute vasodilator response would provide pre-treatment assessment in a more physiological state - the awake patient. This proof-of-concept study showed that it is well tolerated and has shown changes in some stable patients with a Fontan circulation.
Collapse
Affiliation(s)
- Benjamin McConnell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Victoria M Stoll
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Hannah Panayiotou
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Centrum, the Netherlands
| | - Saul G Myerson
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| | - Elizabeth Orchard
- Department of Congenital Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, UK
| |
Collapse
|
3
|
Lee GH, Koo HJ, Park KJ, Yang DH, Ha H. Characterization of baseline hemodynamics after the Fontan procedure: a retrospective cohort study on the comparison of 4D Flow MRI and computational fluid dynamics. Front Physiol 2023; 14:1199771. [PMID: 37304827 PMCID: PMC10248477 DOI: 10.3389/fphys.2023.1199771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction: The aim of this study was to characterize the hemodynamics of Fontan patients using both four-dimensional flow magnetic resonance imaging (4D Flow MRI) and computational fluid dynamics (CFD). Methods: Twenty-nine patients (3.5 ± 0.5 years) who had undergone the Fontan procedure were enrolled, and the superior vena cava (SVC), left pulmonary artery (LPA), right pulmonary artery (RPA), and conduit were segmented based on 4D Flow MRI images. Velocity fields from 4D Flow MRI were used as boundary conditions for CFD simulations. Hemodynamic parameters such as peak velocity (Vmax), pulmonary flow distribution (PFD), kinetic energy (KE), and viscous dissipation (VD) were estimated and compared between the two modalities. Results and discussion: The Vmax, KE, VD, PFDTotal to LPA, and PFDTotal to RPA of the Fontan circulation were 0.61 ± 0.18 m/s, 0.15 ± 0.04 mJ, 0.14 ± 0.04 mW, 41.3 ± 15.7%, and 58.7 ± 15.7% from 4D Flow MRI; and 0.42 ± 0.20 m/s, 0.12 ± 0.05 mJ, 0.59 ± 0.30 mW, 40.2 ± 16.4%, and 59.8 ± 16.4% from CFD, respectively. The overall velocity field, KE, and PFD from the SVC were in agreement between modalities. However, PFD from the conduit and VD showed a large discrepancy between 4D Flow MRI and CFD, most likely due to spatial resolution and data noise. This study highlights the necessity for careful consideration when analyzing hemodynamic data from different modalities in Fontan patients.
Collapse
Affiliation(s)
- Gyu-Han Lee
- Department of Interdisciplinary Program in Biohealth-Machinery Convergence Engineering, Kangwon National University, Chuncheon, Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology, Asan Medical Center, Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Jin Park
- Department of Radiology, Asan Medical Center, Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hojin Ha
- Department of Smart Health Science and Technology, Kangwon National University, Chuncheon, Republic of Korea
| |
Collapse
|
4
|
Puricelli F, Voges I, Gatehouse P, Rigby M, Izgi C, Pennell DJ, Krupickova S. Performance of Cardiac MRI in Pediatric and Adult Patients with Fontan Circulation. Radiol Cardiothorac Imaging 2022; 4:e210235. [PMID: 35833165 PMCID: PMC9274315 DOI: 10.1148/ryct.210235] [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: 09/05/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
Cardiac MRI has become a widely accepted standard for anatomic and functional assessment of complex Fontan physiology, because it is noninvasive and suitable for comprehensive follow-up evaluation after Fontan completion. The use of cardiac MRI in pediatric and adult patients after completion of the Fontan procedure are described, and a practical and experience-based cardiac MRI protocol for evaluating these patients is provided. The current approach and study protocol in use at the authors' institution are presented, which address technical considerations concerning sequences, planning, and optimal image acquisition in patients with Fontan circulation. Additionally, for each sequence, the information that can be obtained and guidance on how to integrate it into clinical decision-making is discussed. Keywords: Pediatrics, MRI, MRI Functional Imaging, Heart, Congenital © RSNA, 2022.
Collapse
|
5
|
Grünwald A, Korte J, Wilmanns N, Winkler C, Linden K, Herberg U, Groß-Hardt S, Steinseifer U, Neidlin M. Intraventricular Flow Simulations in Singular Right Ventricles Reveal Deteriorated Washout and Low Vortex Formation. Cardiovasc Eng Technol 2021; 13:495-503. [PMID: 34850371 PMCID: PMC9197806 DOI: 10.1007/s13239-021-00598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
Purpose Patients with a functionally univentricular heart represent one of the most common severe cardiac lesions with a prevalence of 3 per 10,000 live births. Hemodynamics of the singular ventricle is a major research topic in cardiology and there exists a relationship between fluid dynamical features and cardiac behavior in health and disease. The aim of the present work was to compare intraventricular flow in single right ventricle (SRV) patients and subjects with healthy left hearts (LV) through patient-specific CFD simulations. Methods Three-dimensional real-time echocardiographic images were obtained for five SRV patients and two healthy subjects and CFD simulations with a moving mesh methodology were performed. Intraventricular vortex formation and vortex formation time (VFT) as well as the turbulent kinetic energy (TKE) and ventricular washout were evaluated. Results The results show significantly lower values for the VFT and the TKE in SRV patients compared with healthy LV subjects. Furthermore, vortex formation does not progress to the apex in SRV patients. These findings were confirmed by a significantly lower washout in SRV patients. Conclusions The study pinpoints the intriguing role of intraventricular flows to characterize performance of SRVs that goes beyond standard clinical metrics such as ejection fraction. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00598-9.
Collapse
Affiliation(s)
- Anna Grünwald
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jana Korte
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nadja Wilmanns
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Christian Winkler
- Department of Pediatric Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Katharina Linden
- Department of Pediatric Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Sascha Groß-Hardt
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| |
Collapse
|
6
|
Frank S, Lee J, Lantz J, Ebbers T, Shadden SC. Cardiac Kinetic Energy and Viscous Dissipation Rate From Radial Flow Data. Front Physiol 2021; 12:725104. [PMID: 34630145 PMCID: PMC8493223 DOI: 10.3389/fphys.2021.725104] [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] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Recent studies have correlated kinetic energy (KE) and viscous dissipation rate (VDR) in the left ventricle (LV) with heart health. These studies have relied on 4D-flow imaging or computational fluid dynamics modeling, which are able to measure, or compute, all 3 components (3C) of the blood flow velocity in 3 dimensional (3D) space. This richness of data is difficult to acquire clinically. Alternatively, color Doppler echocardiography (CDE) is more widespread clinically, but only measures a single radial component of velocity and typically only over a planar section. Because of this limitation, prior CDE-based studies have first reconstructed a second component of velocity in the measurement plane prior to evaluating VDR or KE. Herein, we propose 1C-based surrogates of KE and VDR that can be derived directly from the radial component of the flow velocity in the LV. Our results demonstrate that the proposed 1C-based surrogates of KE and VDR are generally as well-correlated with the true KE and VDR values as surrogates that use reconstructed 2C flow data. Moreover, the correlation of these 1C-based surrogates with the true values indicate that CDE (3D in particular) may be useful in evaluating these metrics in practice.
Collapse
Affiliation(s)
- Sarah Frank
- Mechanical Engineering, University of California, Berkeley, Berkeley, CA, United States
| | - Junsung Lee
- Mechanical Engineering, University of California, Berkeley, Berkeley, CA, United States
| | - Jonas Lantz
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Shawn C Shadden
- Mechanical Engineering, University of California, Berkeley, Berkeley, CA, United States
| |
Collapse
|
7
|
Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg 2021; 11:4193-4210. [PMID: 34476199 DOI: 10.21037/qims-20-1234] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Abstract
Magnetic resonance imaging (MRI) four-dimensional (4D) flow is a type of phase-contrast (PC) MRI that uses blood flow encoded in 3 directions, which is resolved relative to 3 spatial and temporal dimensions of cardiac circulation. It can be used to simultaneously quantify and visualize hemodynamics or morphology disorders. 4D flow MRI is more comprehensive and accurate than two-dimensional (2D) PC MRI and echocardiography. 4D flow MRI provides numerous hemodynamic parameters that are not limited to the basic 2D parameters, including wall shear stress (WSS), pulse wave velocity (PWV), kinetic energy, turbulent kinetic energy (TKE), pressure gradient, and flow component analysis. 4D flow MRI is widely used to image many parts of the body, such as the neck, brain, and liver, and has a wide application spectrum to cardiac diseases and large vessels. This present review aims to summarize the hemodynamic parameters of 4D flow MRI technology and generalize their usefulness in clinical practice in relation to the cardiovascular system. In addition, we note the improvements that have been made to 4D flow MRI with the application of new technologies. The application of new technologies can improve the speed of 4D flow, which would benefit clinical applications.
Collapse
Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
8
|
Kamphuis VP, Roest AAW, van den Boogaard PJ, Kroft LJM, Lamb HJ, Helbing WA, Blom NA, Westenberg JJM, Elbaz MSM. Hemodynamic interplay of vorticity, viscous energy loss, and kinetic energy from 4D Flow MRI and link to cardiac function in healthy subjects and Fontan patients. Am J Physiol Heart Circ Physiol 2021; 320:H1687-H1698. [PMID: 33635164 DOI: 10.1152/ajpheart.00806.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to directly assess (patho)physiology of intraventricular hemodynamic interplay between four-dimensional flow cardiovascular magnetic resonance imaging (4D Flow MRI)-derived vorticity with kinetic energy (KE) and viscous energy loss (EL) over the cardiac cycle and their association to ejection fraction (EF) and stroke volume (SV). Fifteen healthy subjects and thirty Fontan patients underwent whole heart 4D Flow MRI. Ventricular vorticity, KE, and EL were computed over systole (vorticity_volavg systole, KEavg systole, and ELavg systole) and diastole (vorticity_volavg diastole, KEavg diastole, and ELavg diastole). The association between vorticity_vol and KE and EL was tested by Spearman correlation. Fontan patients were grouped to normal and impaired EF groups. A significant correlation was found between SV and vorticity in healthy subjects (systolic: ρ = 0.84, P < 0.001; diastolic: ρ = 0.81, P < 0.001) and in Fontan patients (systolic: ρ = 0.61, P < 0.001; diastolic: ρ = 0.54, P = 0.002). Healthy subjects showed positive correlation between vorticity_vol versus KE (systole: ρ = 0.96, P < 0.001; diastole: ρ = 0.90, P < 0.001) and EL (systole: ρ = 0.85, P < 0.001; diastole: ρ = 0.84, P < 0.001). Fontan patients showed significantly elevated vorticity_vol compared with healthy subjects (vorticity_volavg systole: 3.1 [2.3-3.9] vs. 1.7 [1.3-2.4] L/s, P < 0.001; vorticity_volavg diastole: 3.1 [2.0-3.7] vs. 2.1 [1.6-2.8] L/s, P = 0.002). This elevated vorticity in Fontan patients showed strong association with KE (systole: ρ = 0.91, P < 0.001; diastole: ρ = 0.85, P < 0.001) and EL (systole: ρ = 0.82, P < 0.001; diastole: ρ = 0.89, P < 0.001). Fontan patients with normal EF showed significantly higher vorticity_volavg systole and ELavg systole, but significantly decreased KE avg diastole, in the presence of normal SV, compared with healthy subjects. Healthy subjects show strong physiological hemodynamic interplay between vorticity with KE and EL. Fontan patients demonstrate a pathophysiological hemodynamic interplay characterized by correlation of elevated vorticity with KE and EL in the presence of maintained normal stroke volume. Altered vorticity and energetic hemodynamics are found in the presence of normal EF in Fontan patients.NEW & NOTEWORTHY Physiologic intraventricular hemodynamic interplay/coupling is present in the healthy left ventricle between vorticity versus viscous energy loss and kinetic energy from four-dimensional flow cardiovascular magnetic resonance imaging (4D Flow MRI). Conversely, Fontan patients present compensatory pathophysiologic hemodynamic coupling by an increase in intraventricular vorticity that positively correlates to viscous energy loss and kinetic energy levels in the presence of maintained normal stroke volume. Altered vorticity and energetics are found in the presence of normal ejection fraction in Fontan patients.
Collapse
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.,Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem A Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammed S M Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
9
|
Geiger J, Callaghan FM, Burkhardt BEU, Valsangiacomo Buechel ER, Kellenberger CJ. Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: application in neonates and young children. Pediatr Radiol 2021; 51:1503-1517. [PMID: 33313980 PMCID: PMC8266722 DOI: 10.1007/s00247-020-04885-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/08/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Cardiovascular MRI has become an essential imaging modality in children with congenital heart disease (CHD) in the last 15-20 years. With use of appropriate sequences, it provides important information on cardiovascular anatomy, blood flow and function for initial diagnosis and post-surgical or -interventional monitoring in children. Although considered as more sophisticated and challenging than CT, in particular in neonates and infants, MRI is able to provide information on intra- and extracardiac haemodynamics, in contrast to CT. In recent years, four-dimensional (4-D) flow MRI has emerged as an additional MR technique for retrospective assessment and visualisation of blood flow within the heart and any vessel of interest within the acquired three-dimensional (3-D) volume. Its application in young children requires special adaptations for the smaller vessel size and faster heart rate compared to adolescents or adults. In this article, we provide an overview of 4-D flow MRI in various types of complex CHD in neonates and infants to demonstrate its potential indications and beneficial application for optimised individual cardiovascular assessment. We focus on its application in clinical routine cardiovascular workup and, in addition, show some examples with pathologies other than CHD to highlight that 4-D flow MRI yields new insights in disease understanding and therapy planning. We shortly review the essentials of 4-D flow data acquisition, pre- and post-processing techniques in neonates, infants and young children. Finally, we conclude with some details on accuracy, limitations and pitfalls of the technique.
Collapse
Affiliation(s)
- Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Steinwiesstr 75, 8032, Zürich, Switzerland. .,Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland.
| | - Fraser M. Callaghan
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Center for MR research, University Children’s Hospital Zürich, Zürich, Switzerland
| | - Barbara E. U. Burkhardt
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Department of Pediatric Cardiology, University Hospital Zürich, Zürich, Switzerland
| | - Emanuela R. Valsangiacomo Buechel
- Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland ,Department of Pediatric Cardiology, University Hospital Zürich, Zürich, Switzerland
| | - Christian J. Kellenberger
- Department of Diagnostic Imaging, University Children’s Hospital Zürich, Steinwiesstr 75, 8032 Zürich, Switzerland ,Children’s Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland
| |
Collapse
|
10
|
Abstract
Classification of heart failure is based on the left ventricular ejection fraction (EF): preserved EF, midrange EF, and reduced EF. There remains an unmet need for further heart failure phenotyping of ventricular structure-function relationships. Because of high spatiotemporal resolution, cardiac magnetic resonance (CMR) remains the reference modality for quantification of ventricular contractile function. The authors aim to highlight novel frameworks, including theranostic use of ferumoxytol, to enable more efficient evaluation of ventricular function in heart failure patients who are also frequently anemic, and to discuss emerging quantitative CMR approaches for evaluation of ventricular structure-function relationships in heart failure.
Collapse
|
11
|
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.
Collapse
Affiliation(s)
- Judy Rizk
- Department of Cardiology, Faculty of Medicine, Alexandria University, El-Khartoum Square, Alexandria, 21521, Egypt.
| |
Collapse
|
12
|
Budts W, Ravekes WJ, Danford DA, Kutty S. Diastolic Heart Failure in Patients With the Fontan Circulation. JAMA Cardiol 2020; 5:590-597. [DOI: 10.1001/jamacardio.2019.5459] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Werner Budts
- University Hospitals Leuven, Congenital and Structural Cardiology, Catholic University of Leuven, Leuven, Belgium
| | - William J. Ravekes
- The Helen B. Taussig Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A. Danford
- Pediatric Cardiology, University of Nebraska College of Medicine, Omaha
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
13
|
Töger J, Zahr MJ, Aristokleous N, Markenroth Bloch K, Carlsson M, Persson P. Blood flow imaging by optimal matching of computational fluid dynamics to 4D‐flow data. Magn Reson Med 2020; 84:2231-2245. [DOI: 10.1002/mrm.28269] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Johannes Töger
- Department of Clinical Sciences Lund Diagnostic Radiology Lund UniversitySkåne University Hospital Lund Sweden
- Department of Clinical Sciences Lund Clinical Physiology Lund UniversitySkåne University Hospital Lund Sweden
| | - Matthew J. Zahr
- Mathematics Group Lawrence Berkeley National Laboratory Berkeley CA
- Department of Aerospace and Mechanical Engineering University of Notre Dame Notre Dame IN
| | - Nicolas Aristokleous
- Department of Clinical Sciences Lund Clinical Physiology Lund UniversitySkåne University Hospital Lund Sweden
| | | | - Marcus Carlsson
- Department of Clinical Sciences Lund Clinical Physiology Lund UniversitySkåne University Hospital Lund Sweden
| | - Per‐Olof Persson
- Mathematics Group Lawrence Berkeley National Laboratory Berkeley CA
- Department of Mathematics University of California Berkeley CA
| |
Collapse
|
14
|
Stoll VM, Hess AT, Rodgers CT, Bissell MM, Dyverfeldt P, Ebbers T, Myerson SG, Carlhäll CJ, Neubauer S. Left Ventricular Flow Analysis. Circ Cardiovasc Imaging 2020; 12:e008130. [PMID: 31109184 DOI: 10.1161/circimaging.118.008130] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiac remodeling, after a myocardial insult, often causes progression to heart failure. The relationship between alterations in left ventricular blood flow, including kinetic energy (KE), and remodeling is uncertain. We hypothesized that increasing derangements in left ventricular blood flow would relate to (1) conventional cardiac remodeling markers, (2) increased levels of biochemical remodeling markers, (3) altered cardiac energetics, and (4) worsening patient symptoms and functional capacity. Methods Thirty-four dilated cardiomyopathy patients, 30 ischemic cardiomyopathy patients, and 36 controls underwent magnetic resonance including 4-dimensional flow, BNP (brain-type natriuretic peptide) measurement, functional capacity assessment (6-minute walk test), and symptom quantification. A subgroup of dilated cardiomyopathy and control subjects underwent cardiac energetic assessment. Left ventricular flow was separated into 4 components: direct flow, retained inflow, delayed ejection flow, and residual volume. Average KE throughout the cardiac cycle was calculated. RESULTS Patients had reduced direct flow proportion and direct-flow average KE compared with controls ( P<0.0001). The residual volume proportion and residual volume average KE were increased in patients ( P<0.0001). Importantly, in a multiple linear regression model to predict the patient's 6-minute walk test, the independent predictors were age (β=-0.3015; P=0.019) and direct-flow average KE (β=0.280, P=0.035; R2 model, 0.466, P=0.002). In contrast, neither ejection fraction nor left ventricular volumes were independently predictive. CONCLUSIONS This study demonstrates an independent predictive relationship between the direct-flow average KE and a prognostic measure of functional capacity. Intracardiac 4-dimensional flow parameters are novel biomarkers in heart failure and may provide additive value in monitoring new therapies and predicting prognosis.
Collapse
Affiliation(s)
- Victoria M Stoll
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom (V.M.S., A.T.H., C.T.R., M.M.B., S.G.M., S.N.)
| | - Aaron T Hess
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom (V.M.S., A.T.H., C.T.R., M.M.B., S.G.M., S.N.)
| | - Christopher T Rodgers
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom (V.M.S., A.T.H., C.T.R., M.M.B., S.G.M., S.N.).,Wolfson Brain Imaging Centre, University of Cambridge, United Kingdom (C.T.R.)
| | - Malenka M Bissell
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom (V.M.S., A.T.H., C.T.R., M.M.B., S.G.M., S.N.)
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences (P.D., T.E., C.-J.C.), Linköping University, Sweden.,Center for Medical Image Science and Visualization (P.D., T.E., C.-J.C.), Linköping University, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences (P.D., T.E., C.-J.C.), Linköping University, Sweden.,Center for Medical Image Science and Visualization (P.D., T.E., C.-J.C.), Linköping University, Sweden
| | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom (V.M.S., A.T.H., C.T.R., M.M.B., S.G.M., S.N.)
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences (P.D., T.E., C.-J.C.), Linköping University, Sweden.,Center for Medical Image Science and Visualization (P.D., T.E., C.-J.C.), Linköping University, Sweden.,Department of Clinical Physiology (C.-J.C.), Linköping University, Sweden.,Department of Medical and Health Sciences (C.-J.C.), Linköping University, Sweden
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom (V.M.S., A.T.H., C.T.R., M.M.B., S.G.M., S.N.)
| |
Collapse
|
15
|
Rutkowski DR, Barton GP, François CJ, Aggarwal N, Roldán-Alzate A. Sex Differences in Cardiac Flow Dynamics of Healthy Volunteers. Radiol Cardiothorac Imaging 2020; 2. [PMID: 32666051 DOI: 10.1148/ryct.2020190058] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose The purpose of this study was to further understand the relationship between cardiac function and flow, on the basis of sex, by quantifying cardiac flow characteristics and relating them to cardiac muscle performance in young adults. Materials and Methods In this cross-sectional study, cardiac four-dimensional flow (4D flow) magnetic resonance imaging (MRI) and two-dimensional cine MRI were performed on 20 male and 19 female volunteers aged 20-35. Velocity-based metrics of flow, kinetic energy, vorticity, and efficiency indices were quantified, as well as cardiac strain metrics. Results* Peak systolic blood kinetic energy (male: 4.76 ± 2.66 mJ; female: 3.36 ± 1.43 mJ; p=0.047) was significantly higher in the male left ventricle (LV) than in the female LV. Peak systolic vorticity index (male: 0.008 ± 0.005 rad-m2/ml-s; female: 0.014 ± 0.007 rad-m2/ml-s; p=0.007), peak diastolic vorticity index (male: 0.007 ± 0.006 rad-m2/ml-s; female: 0.014 ± 0.010 rad-m2/ml-s; p=0.015), and cycle-average vorticity (male: 0.006 ± 0.001 rad-m2/ml-s; female: 0.011 ± 0.002 rad/s; p=0.001) were all significantly higher in the LV of women than they were in the LV of men. Radial, circumferential, and long-axis strain metrics were significantly higher in the female LV than in the male LV (p<0.05). Circumferential systolic and diastolic strain rates displayed moderate correlation to peak systolic (r=-0.38, p=0.022) and diastolic vorticity (r=0.40, p=0.015) values, respectively. *Results are reported as mean ± standard deviation. Conclusion Left ventricular vorticity metrics were observed to be higher in women than in men and displayed moderate correlation to cardiac strain metrics. The methods and results of this study may be used to further understand the sex-based cardiac efficiency relationship between cardiac function and flow.
Collapse
Affiliation(s)
- David R Rutkowski
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Gregory P Barton
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Christopher J François
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Niti Aggarwal
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Alejandro Roldán-Alzate
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| |
Collapse
|
16
|
Warmerdam E, Krings GJ, Leiner T, Grotenhuis HB. Three-dimensional and four-dimensional flow assessment in congenital heart disease. Heart 2019; 106:421-426. [PMID: 31857355 DOI: 10.1136/heartjnl-2019-315797] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/08/2019] [Accepted: 11/20/2019] [Indexed: 01/27/2023] Open
Abstract
Congenital heart disease (CHD) is the most common form of congenital defects, with an incidence of 8 per 1000 births. Due to major advances in diagnostics, perioperative care and surgical techniques, the survival rate of patients with CHD has improved dramatically. Conversely, although 70%-95% of infants with CHD survive into adulthood, the rate of long-term morbidity, which often requires (repeat) intervention, has increased. Recently, the role of altered haemodynamics in cardiac development and CHD has become a subject of interest. Patients with CHD often have abnormal blood flow patterns, either due to the primary cardiac defect or as a consequence of the surgical intervention(s). Research suggests that these abnormal blood flow patterns may contribute to diminished cardiac and vascular function. Serial assessment of haemodynamic parameters in patients with CHD may allow for improved understanding of the often complex haemodynamics in these patients and thereby potentially guide the timing and nature of interventions with the aim of preventing progression of cardiovascular deterioration. In this article we will discuss two novel non-invasive four-dimensional (4D) techniques to evaluate cardiovascular haemodynamics: 4D-flow cardiac magnetic resonance and computational fluid dynamics. This review focuses on the additional value of these two modalities in the evaluation of patients with CHD with abnormal flow patterns, who could benefit from advanced haemodynamic evaluation: patients with coarctation of the aorta, bicuspid aortic valve, tetralogy of Fallot and patients after Fontan palliation.
Collapse
Affiliation(s)
- Evangeline Warmerdam
- Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Pediatric Cardiology, Wilhelmina Children's Hospital University Medical Center, Utrecht, The Netherlands
| | - Gregor J Krings
- Pediatric Cardiology, Wilhelmina Children's Hospital University Medical Center, Utrecht, The Netherlands
| | - Tim Leiner
- Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Pediatric Cardiology, Wilhelmina Children's Hospital University Medical Center, Utrecht, The Netherlands .,Pediatric Cardiology, Universitair Medisch Centrum Utrecht - Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| |
Collapse
|
17
|
Kamphuis VP, Elbaz MSM, van den Boogaard PJ, Kroft LJM, Lamb HJ, Hazekamp MG, Jongbloed MRM, Blom NA, Helbing WA, Roest AAW, Westenberg JJM. Stress increases intracardiac 4D flow cardiovascular magnetic resonance -derived energetics and vorticity and relates to VO 2max in Fontan patients. J Cardiovasc Magn Reson 2019; 21:43. [PMID: 31340834 PMCID: PMC6657113 DOI: 10.1186/s12968-019-0553-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/14/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity. METHODS Ten Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 μg/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_volavg cycle, KEavg cycle, ELavg cycle). The relation to maximum oxygen uptake (VO2 max) from CPET was tested by Pearson's correlation or Spearman's rank correlation in case of non-normality of the data. RESULTS Dobutamine stress caused a significant 88 ± 52% increase in KE (KEavg cycle: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (ELavg cycle: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_volavg cycle: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO2 max (KEavg cycle: r = - 0.83, P = 0.003; ELavg cycle: r = - 0.80, P = 0.006; vorticity_volavg cycle: r = - 0.64, P = 0.047). CONCLUSIONS 4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO2 max.
Collapse
Affiliation(s)
- Vivian P. Kamphuis
- Department of Pediatrics division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Mohammed S. M. Elbaz
- Department of Radiology Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Lucia J. M. Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J. Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark G. Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nico A. Blom
- Department of Pediatrics division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pediatrics division of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics division of Pediatric Cardiology, Radboud university Medical Center, Nijmegen, the Netherlands
| | - Arno A. W. Roest
- Department of Pediatrics division of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos J. M. Westenberg
- Department of Radiology Feinberg School of Medicine, Northwestern University, Chicago, USA
| |
Collapse
|
18
|
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: 85] [Impact Index Per Article: 17.0] [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 .
Collapse
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.)
| |
Collapse
|
19
|
Bock J, Töger J, Bidhult S, Markenroth Bloch K, Arvidsson P, Kanski M, Arheden H, Testud F, Greiser A, Heiberg E, Carlsson M. Validation and reproducibility of cardiovascular 4D-flow MRI from two vendors using 2 × 2 parallel imaging acceleration in pulsatile flow phantom and in vivo with and without respiratory gating. Acta Radiol 2019; 60:327-337. [PMID: 30479136 PMCID: PMC6402051 DOI: 10.1177/0284185118784981] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background 4D-flow magnetic resonance imaging (MRI) is increasingly used. Purpose To validate 4D-flow sequences in phantom and in vivo, comparing volume flow
and kinetic energy (KE) head-to-head, with and without respiratory
gating. Material and Methods Achieva dStream (Philips Healthcare) and MAGNETOM Aera (Siemens Healthcare)
1.5-T scanners were used. Phantom validation measured pulsatile,
three-dimensional flow with 4D-flow MRI and laser particle imaging
velocimetry (PIV) as reference standard. Ten healthy participants underwent
three cardiac MRI examinations each, consisting of cine-imaging, 2D-flow
(aorta, pulmonary artery), and 2 × 2 accelerated 4D-flow with (Resp+) and
without (Resp−) respiratory gating. Examinations were acquired consecutively
on both scanners and one examination repeated within two weeks. Volume flow
in the great vessels was compared between 2D- and 4D-flow. KE were
calculated for all time phases and voxels in the left ventricle. Results Phantom results showed high accuracy and precision for both scanners.
In vivo, higher accuracy and precision (P < 0.001) was
found for volume flow for the Aera prototype with Resp+ (–3.7 ± 10.4 mL,
r = 0.89) compared to the Achieva product sequence (–17.8 ± 18.6 mL,
r = 0.56). 4D-flow Resp− on Aera had somewhat larger bias (–9.3 ± 9.6 mL,
r = 0.90) compared to Resp+ (P = 0.005). KE measurements
showed larger differences between scanners on the same day compared to the
same scanner at different days. Conclusion Sequence-specific in vivo validation of 4D-flow is needed before clinical
use. 4D-flow with the Aera prototype sequence with a clinically acceptable
acquisition time (<10 min) showed acceptable bias in healthy controls to
be considered for clinical use. Intra-individual KE comparisons should use
the same sequence.
Collapse
Affiliation(s)
- Jelena Bock
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Johannes Töger
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
- Department of Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Sebastian Bidhult
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Karin Markenroth Bloch
- Philips Healthcare, Lund, Sweden
- Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Per Arvidsson
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | | | | | - Einar Heiberg
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences, Lund University, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
20
|
Rutkowski DR, Barton G, François CJ, Bartlett HL, Anagnostopoulos PV, Roldán-Alzate A. Analysis of cavopulmonary and cardiac flow characteristics in fontan Patients: Comparison with healthy volunteers. J Magn Reson Imaging 2019; 49:1786-1799. [PMID: 30635978 DOI: 10.1002/jmri.26583] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Characterizing the flow of the Fontan circuit, and correlating flow characteristics with the development of complications, is an important clinical challenge. Past work has analyzed the flow characteristics of Fontan circulation on a component-by-component basis. 4D flow MRI with radial projections allows for large volumetric coverage, and therefore can be used to analyze the flow through many codependent cardiovascular components in a single imaging session. PURPOSE To describe flow characteristics across the entire Fontan circuit and to compare these with the flow characteristics in healthy volunteers. STUDY TYPE Prospective. SUBJECTS Eleven single ventricle patients with a Fontan connection and 15 healthy controls. SEQUENCE Phase contrast with vastly undersampled isotropic projection reconstruction (PC-VIPR) at a field strength of 3 T. ASSESSMENT Cavopulmonary and ventricular flow distributions, blood flow kinetic energy, vorticities, efficiency indices, and other flow parameters were analyzed using Ensight and MatLab. STATISTICAL TESTS The results were compared across Fontan subjects, between respiratory phases, and between Fontan subjects and healthy volunteers using a Student's t-test for unequal sample sizes and linear regression. RESULTS Cava-specific pulmonary flow distributions of Fontan patients varied significantly between respiratory phases (P < 0.05). Ventricular kinetic energy (KE) was significantly higher in Fontan patients than it was in healthy controls, leading to a lower cardiac efficiency metric in the Fontan group. A significant diastolic KE time-shift was also observed in the Fontan patient group. Peak diastolic KE was significantly higher in the single ventricle of patients with right ventricle morphology than it was in left ventricle morphology patients. DATA CONCLUSION Radial 4D flow MRI can be used for comprehensive analysis of single ventricle Fontan flow characteristics. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019.
Collapse
Affiliation(s)
- David R Rutkowski
- Mechanical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Gregory Barton
- Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Heather L Bartlett
- Pediatrics and Medicine, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | | | - Alejandro Roldán-Alzate
- Mechanical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin - Madison, Madison, Wisconsin, USA.,Biomedical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA
| |
Collapse
|
21
|
Chen Z, Li Y, Li C, Tang H, Wang H, Zhong Y, Cai Y, Rao L. Right Ventricular Dissipative Energy Loss Detected by Vector Flow Mapping in Children: Characteristics of Normal Values. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:131-140. [PMID: 30027672 DOI: 10.1002/jum.14674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/23/2018] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The feasible application of vector flow mapping (VFM)-derived right ventricular (RV) energy loss (EL) is lacking. This study was designed to determine reference values of VFM-derived EL within the right ventricle and evaluate potential correlated variables. METHODS A total of 90 healthy children were enrolled. Velocity vector fields of the intra-RV outflow tract and pulmonary trunk (OP) and RV blood flow were obtained from the parasternal short-axis view and RV focused apical 4-chamber view, respectively. RV-EL and OP-EL values during diastole and systole were calculated using VFM analysis. The potential relationships between demographic and echocardiographic parameters and the dissipative EL were also identified. RESULTS Mean subject age was 8.99 ± 5.35 years. The median (interquartile range) values were 8.82 (5.47-14.30) W/m for RV diastolic EL, 3.17 (2.11-5.54) W/m for RV systolic EL, 18.82 (13.93-24.92) W/m for OP diastolic EL, and 29.88 (20.62-40.78) W/m for OP systolic EL, respectively. The dissipative EL values were negatively correlated with age and RV global strain, and positively correlated with heart rate and RV Tei index. Multivariate analysis showed that age was the primary independent predictor of these 4 types of EL, while heart rate and strain were contributors of the RV diastolic EL and OP systolic EL. CONCLUSIONS The present study initially validated the application of vector flow mapping-derived EL analysis in right ventricle and established reference values for the future assessment of children with cardiopulmonary disease. Age, heart rate, and strain were independent variables correlated with the dissipative EL.
Collapse
Affiliation(s)
- Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yajiao Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chen Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Hong Tang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Hui Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yue Zhong
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuyan Cai
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Rao
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
22
|
Lantz J, Gupta V, Henriksson L, Karlsson M, Persson A, Carlhäll CJ, Ebbers T. Intracardiac Flow at 4D CT: Comparison with 4D Flow MRI. Radiology 2018; 289:51-58. [DOI: 10.1148/radiol.2018173017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Kamphuis VP, Elbaz MSM, van den Boogaard PJ, Kroft LJM, van der Geest RJ, de Roos A, Helbing WA, Blom NA, Westenberg JJM, Roest AAW. Disproportionate intraventricular viscous energy loss in Fontan patients: analysis by 4D flow MRI. Eur Heart J Cardiovasc Imaging 2018; 20:323-333. [DOI: 10.1093/ehjci/jey096] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/27/2018] [Accepted: 06/30/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vivian P Kamphuis
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
- Netherlands Heart Institute, Holland Heart House, Moreelsepark 1, EP Utrecht, The Netherlands
| | - Mohammed S M Elbaz
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Ave, Suite 1600, Chicago, IL, USA
| | - Pieter J van den Boogaard
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Willem A Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Center, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| |
Collapse
|
24
|
Rijnberg FM, Hazekamp MG, Wentzel JJ, de Koning PJ, Westenberg JJ, Jongbloed MR, Blom NA, Roest AA. Energetics of Blood Flow in Cardiovascular Disease. Circulation 2018; 137:2393-2407. [DOI: 10.1161/circulationaha.117.033359] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Jolanda J. Wentzel
- Leiden University Medical Center, The Netherlands. Department of Biomechanical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands (J.J.W.)
| | | | | | | | - Nico A. Blom
- Department of Pediatric Cardiology (N.A.B., A.A.W.R.)
| | | |
Collapse
|
25
|
Sjöberg P, Bidhult S, Bock J, Heiberg E, Arheden H, Gustafsson R, Nozohoor S, Carlsson M. Disturbed left and right ventricular kinetic energy in patients with repaired tetralogy of Fallot: pathophysiological insights using 4D-flow MRI. Eur Radiol 2018; 28:4066-4076. [PMID: 29666995 PMCID: PMC6132722 DOI: 10.1007/s00330-018-5385-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Indications for pulmonary valve replacement (PVR) in patients with pulmonary regurgitation (PR) after repaired tetralogy of Fallot (rToF) are debated. We aimed to compare right (RV) and left ventricular (LV) kinetic energy (KE) measured by 4D-flow magnetic resonance imaging (MRI) in patients to controls, to further understand the pathophysiological effects of PR. METHODS Fifteen patients with rToF with PR > 20% and 14 controls underwent MRI. Ventricular volumes and KE were quantified from cine MRI and 4D-flow, respectively. Lagrangian coherent structures were used to discriminate KE in the PR. Restrictive RV physiology was defined as end-diastolic forward flow. RESULTS LV systolic peak KE was lower in rToF, 2.8 ± 1.1 mJ, compared to healthy volunteers, 4.8 ± 1.1 mJ, p < 0.0001. RV diastolic peak KE was higher in rToF (7.7 ± 4.3 mJ vs 3.1 ± 1.3 mJ, p = 0.0001) and the difference most pronounced in patients with non-restrictive RV physiology. KE was primarily located in the PR volume at the time of diastolic peak KE, 64 ± 17%. CONCLUSION This is the first study showing disturbed KE in patients with rToF and PR, in both the RV and LV. The role of KE as a potential early marker of ventricular dysfunction to guide intervention needs to be addressed in future studies. KEY POINTS • Kinetic energy (KE) reflects ventricular performance • KE is a potential marker of ventricular dysfunction in Fallot patients • KE is disturbed in both ventricles in patients with tetralogy of Fallot • KE contributes to the understanding of the pathophysiology of pulmonary regurgitation • Lagrangian coherent structures enable differentiation of ventricular inflows.
Collapse
Affiliation(s)
- Pia Sjöberg
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.
| | - Sebastian Bidhult
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Jelena Bock
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.,Center for Mathematics, Faculty of Engineering, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Department of Clinical Sciences, Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Shahab Nozohoor
- Department of Clinical Sciences, Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
26
|
Ota H, Higuchi S, Sun W, Ueda T, Takase K, Tamura H. Four-Dimensional Flow Magnetic Resonance Imaging for Cardiovascular Imaging: from Basic Concept to Clinical Application. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Wenyu Sun
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Takuya Ueda
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hajime Tamura
- Division of Medical Physics, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|