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Dmytriw AA, Bickford S, Pezeshkpour P, Ha W, Amirabadi A, Dibas M, Kitamura LA, Vidarsson L, Pulcine E, Muthusami P. Rotational Vertebrobasilar Insufficiency: Is There a Physiological Spectrum? Phase-Contrast Magnetic Resonance Imaging Quantification in Healthy Volunteers. Pediatr Neurol 2022; 128:58-64. [PMID: 35101804 DOI: 10.1016/j.pediatrneurol.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some cases of cerebral ischemia have been attributed to dynamic flow limitation in neck vessels. It however remains unknown whether this represents the extreme end of a physiological response. METHODS Eighteen healthy volunteers were recruited to this prospective study. Cervical blood flow (ml/min/m2) was assessed using phase-contrast MRI, and cerebral perfusion ratios were assessed using arterial spin labeling perfusion at neutral position, predefined head rotations, as well as flexion and extension. Inter-reader agreements were assessed using intraclass correlation coefficient. RESULTS The mean age was 38.6 ± 10.8 (range = 22-56) years, for five male participants and 13 females. The means for height and weight were 168 cm and 73.2 kg, respectively. There were no significant differences in individual arterial blood flow with change in head position (P > 0.05). Similarly, the repeated-measures analysis of variance test demonstrated no significant difference in perfusion ratios in relation to head position movement (P > 0.05). Inter-reader agreement was excellent (intraclass correlation coefficient = 0.97). CONCLUSIONS There is neither significant change in either individual cervical arterial blood flow nor cerebral perfusion within the normal physiological/anatomical range of motion in healthy individuals. It is therefore reasonable to conclude that any such hemodynamic change identified in a patient with ischemic stroke be considered causative.
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Affiliation(s)
- Adam A Dmytriw
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Suzanne Bickford
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Parneyan Pezeshkpour
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Winston Ha
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Dibas
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Lee Ann Kitamura
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Logi Vidarsson
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Pulcine
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
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de Boer A, Villa G, Bane O, Bock M, Cox EF, Dekkers IA, Eckerbom P, Fernández‐Seara MA, Francis ST, Haddock B, Hall ME, Hall Barrientos P, Hermann I, Hockings PD, Lamb HJ, Laustsen C, Lim RP, Morris DM, Ringgaard S, Serai SD, Sharma K, Sourbron S, Takehara Y, Wentland AL, Wolf M, Zöllner FG, Nery F, Caroli A. Consensus-Based Technical Recommendations for Clinical Translation of Renal Phase Contrast MRI. J Magn Reson Imaging 2022; 55:323-335. [PMID: 33140551 PMCID: PMC9291014 DOI: 10.1002/jmri.27419] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Phase-contrast (PC) MRI is a feasible and valid noninvasive technique to measure renal artery blood flow, showing potential to support diagnosis and monitoring of renal diseases. However, the variability in measured renal blood flow values across studies is large, most likely due to differences in PC-MRI acquisition and processing. Standardized acquisition and processing protocols are therefore needed to minimize this variability and maximize the potential of renal PC-MRI as a clinically useful tool. PURPOSE To build technical recommendations for the acquisition, processing, and analysis of renal 2D PC-MRI data in human subjects to promote standardization of renal blood flow measurements and facilitate the comparability of results across scanners and in multicenter clinical studies. STUDY TYPE Systematic consensus process using a modified Delphi method. POPULATION Not applicable. SEQUENCE FIELD/STRENGTH Renal fast gradient echo-based 2D PC-MRI. ASSESSMENT An international panel of 27 experts from Europe, the USA, Australia, and Japan with 6 (interquartile range 4-10) years of experience in 2D PC-MRI formulated consensus statements on renal 2D PC-MRI in two rounds of surveys. Starting from a recently published systematic review article, literature-based and data-driven statements regarding patient preparation, hardware, acquisition protocol, analysis steps, and data reporting were formulated. STATISTICAL TESTS Consensus was defined as ≥75% unanimity in response, and a clear preference was defined as 60-74% agreement among the experts. RESULTS Among 60 statements, 57 (95%) achieved consensus after the second-round survey, while the remaining three showed a clear preference. Consensus statements resulted in specific recommendations for subject preparation, 2D renal PC-MRI data acquisition, processing, and reporting. DATA CONCLUSION These recommendations might promote a widespread adoption of renal PC-MRI, and may help foster the set-up of multicenter studies aimed at defining reference values and building larger and more definitive evidence, and will facilitate clinical translation of PC-MRI. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Anneloes de Boer
- Department of RadiologyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Giulia Villa
- Department of BioengineeringIstituto di Ricerche Farmacologiche Mario Negri IRCCSBergamoItaly
| | - Octavia Bane
- Biomedical Engineering and Imaging Institute/RadiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Michael Bock
- Department of Radiology ‐ Medical Physics, Medical CenterUniversity of Freiburg, Faculty of Medicine, University of FreiburgFreiburgGermany
| | - Eleanor F. Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Ilona A. Dekkers
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Per Eckerbom
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | | | - Susan T. Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Bryan Haddock
- Department of Clinical Physiology, Nuclear Medicine and PET, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Michael E. Hall
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | | | - Ingo Hermann
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
| | | | - Hildo J. Lamb
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Christoffer Laustsen
- Department of Clinical Medicine, MR Research CentreAarhus UniversityAarhusDenmark
| | - Ruth P. Lim
- Departments of Radiology, Surgery and MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of RadiologyAustin HealthHeidelbergVictoriaAustralia
| | - David M. Morris
- Centre for Inflammation ResearchUniversity of Edinburgh, Edinburgh BioquarterEdinburghUK
| | - Steffen Ringgaard
- Department of Clinical Medicine, MR Research CentreAarhus UniversityAarhusDenmark
| | - Suraj D. Serai
- Department of RadiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kanishka Sharma
- Department of Imaging, Infection, Immunity and Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Steven Sourbron
- Department of Imaging, Infection, Immunity and Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic ImagingNagoya University, Graduate School of MedicineNagoyaJapan
| | | | - Marcos Wolf
- High Field MR Center, Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Frank G. Zöllner
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Fabio Nery
- Developmental Imaging and Biophysics SectionUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Anna Caroli
- Department of BioengineeringIstituto di Ricerche Farmacologiche Mario Negri IRCCSBergamoItaly
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Four-Dimensional Phase Contrast Magnetic Resonance Imaging Protocol Optimization Using Patient-Specific 3-Dimensional Printed Replicas for In Vivo Imaging Before and After Flow Diverter Placement. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kowallick JT, Steinmetz M, Schuster A, Unterberg-Buchwald C, Nguyen TT, Fasshauer M, Staab W, Hösch O, Rosenberg C, Paul T, Lotz J, Sohns JM. Non-invasive estimation of pulmonary outflow tract obstruction: A comparative study of cardiovascular phase contrast magnetic resonance and Doppler echocardiography versus cardiac catheterization. IJC HEART & VASCULATURE 2015; 10:1-7. [PMID: 28616508 PMCID: PMC5441337 DOI: 10.1016/j.ijcha.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 10/26/2022]
Abstract
AIM To compare estimated pressure gradients from routine follow-up cardiovascular phase-contrast magnetic resonance (PC-MR) with those from Doppler echocardiography and invasive catheterization in patients with congenital heart disease (CHD) and pulmonary outflow tract obstruction. METHODS In 75 patients with pulmonary outflow tract obstruction maximal and mean PC-MR gradients were compared to maximal and mean Doppler gradients. Additionally, in a subgroup of 31 patients maximal and mean PC-MR and Doppler pressure gradients were compared to catheter peak-to-peak pressure gradients (PPG). RESULTS Maximal and mean PC-MR gradients underestimated pulmonary outflow tract obstruction as compared to Doppler (max gradient: bias = + 8.4 mm Hg (+ 47.6%), r = 0.89, p < 0.001; mean gradient: + 4.3 mm Hg (+ 49.0%), r = 0.88, p < 0.001). However, in comparison to catheter PPG, maximal PC-MR gradients (bias = + 1.8 mm Hg (+ 8.8%), r = 0.90, p = 0.14) and mean Doppler gradients (bias = - 2.3 mm Hg (- 11.2%), r = 0.87, p = 0.17) revealed best agreement. Mean PC-MR gradients underestimated (bias = - 7.7 mm Hg (- 55.6%), r = 0.90, p < 0.001) while maximal Doppler gradients systematically overestimated catheter PPG (bias = + 13.9 mm Hg (+ 56.5%), r = 0.88, p < 0.001). CONCLUSIONS Estimated maximal PC-MR pressure gradients from routine CHD follow-up agree well with invasively assessed peak-to-peak pressure gradients. Estimated maximal Doppler pressure gradients tend to overestimate, while Doppler mean gradients agree better with catheter PPG. Therefore, our data provide reasonable arguments to either apply maximal PC-MR gradients or mean Doppler gradients to non-invasively evaluate the severity of pulmonary outflow tract obstruction in the follow-up of CHD.
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Affiliation(s)
- Johannes Tammo Kowallick
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Christina Unterberg-Buchwald
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Thuy-Trang Nguyen
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Centre Göttingen, Germany
| | - Martin Fasshauer
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Wieland Staab
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Olga Hösch
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Centre Göttingen, Germany
| | - Christina Rosenberg
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Centre Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Jan Martin Sohns
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
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Klug G, Reinstadler SJ, Feistritzer HJ, Kremser C, Schwaiger JP, Reindl M, Mair J, Müller S, Mayr A, Franz WM, Metzler B. Cardiac index after acute ST-segment elevation myocardial infarction measured with phase-contrast cardiac magnetic resonance imaging. Eur Radiol 2015; 26:1999-2008. [PMID: 26385805 DOI: 10.1007/s00330-015-4022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/02/2015] [Accepted: 09/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Phase-contrast CMR (PC-CMR) might provide a fast and robust non-invasive determination of left ventricular function in patients after ST-segment elevation myocardial infarction (STEMI). METHODS Cine sequences in the left-ventricular (LV) short-axis and free-breathing, retrospectively gated PC-CMR were performed in 90 patients with first acute STEMI and 15 healthy volunteers. Inter- and intra-observer agreement was determined. The correlations of clinical variables (age, gender, ejection fraction, NT pro-brain natriuretic peptide [NT-proBNP] with cardiac index (CI) were calculated. RESULTS For CI, there was a strong agreement of cine CMR with PC-CMR in healthy volunteers (r: 0.82, mean difference: -0.14 l/min/m(2), error ± 23 %). Agreement was lower in STEMI patients (r: 0.61, mean difference: -0.17 l/min/m(2), error ± 32 %). In STEMI patients, CI measured with PC-CMR showed lower intra-observer (1 % vs. 9 %) and similar inter-observer variability (9 % vs. 12 %) compared to cine CMR. CI was significantly correlated with age, ejection fraction and NT-proBNP values in STEMI patients. DISCUSSION The agreement of PC-CMR and cine CMR for the determination of CI is lower in STEMI patients than in healthy volunteers. After acute STEMI, CI measured with PC-CMR decreases with age, LV ejection fraction and higher NT-proBNP. KEY POINTS • Cine CMR and PC-CMR correlate well in healthy volunteers. • Agreement is lower in STEMI patients. • Cardiac Output should be measured with one method longitudinally. • Cardiac output decreases with age after myocardial infarction.
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Affiliation(s)
- Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes P Schwaiger
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Johannes Mair
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvana Müller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang-Michael Franz
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Nayak KS, Nielsen JF, Bernstein MA, Markl M, D Gatehouse P, M Botnar R, Saloner D, Lorenz C, Wen H, S Hu B, Epstein FH, N Oshinski J, Raman SV. Cardiovascular magnetic resonance phase contrast imaging. J Cardiovasc Magn Reson 2015; 17:71. [PMID: 26254979 PMCID: PMC4529988 DOI: 10.1186/s12968-015-0172-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) phase contrast imaging has undergone a wide range of changes with the development and availability of improved calibration procedures, visualization tools, and analysis methods. This article provides a comprehensive review of the current state-of-the-art in CMR phase contrast imaging methodology, clinical applications including summaries of past clinical performance, and emerging research and clinical applications that utilize today's latest technology.
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Affiliation(s)
- Krishna S Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, California, 90089-2564, USA.
| | - Jon-Fredrik Nielsen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | | | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, USA.
| | - Peter D Gatehouse
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Rene M Botnar
- Cardiovascular Imaging, Imaging Sciences Division, Kings's College London, London, UK.
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Christine Lorenz
- Center for Applied Medical Imaging, Siemens Corporation, Baltimore, MD, USA.
| | - Han Wen
- Imaging Physics Laboratory, National Heart Lung and Blood Institute, Bethesda, MD, USA.
| | - Bob S Hu
- Palo Alto Medical Foundation, Palo Alto, CA, USA.
| | - Frederick H Epstein
- Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | - John N Oshinski
- Departments of Radiology and Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, USA.
| | - Subha V Raman
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
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Sekine T, Amano Y, Takagi R, Matsumura Y, Murai Y, Kumita S. Feasibility of 4D flow MR imaging of the brain with either Cartesian y-z radial sampling or k-t SENSE: comparison with 4D Flow MR imaging using SENSE. Magn Reson Med Sci 2014; 13:15-24. [PMID: 24492737 DOI: 10.2463/mrms.2013-0008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A drawback of time-resolved 3-dimensional phase contrast magnetic resonance (4D Flow MR) imaging is its lengthy scan time for clinical application in the brain. We assessed the feasibility for flow measurement and visualization of 4D Flow MR imaging using Cartesian y-z radial sampling and that using k-t sensitivity encoding (k-t SENSE) by comparison with the standard scan using SENSE. MATERIALS AND METHODS Sixteen volunteers underwent 3 types of 4D Flow MR imaging of the brain using a 3.0-tesla scanner. As the standard scan, 4D Flow MR imaging with SENSE was performed first and then followed by 2 types of acceleration scan-with Cartesian y-z radial sampling and with k-t SENSE. We measured peak systolic velocity (PSV) and blood flow volume (BFV) in 9 arteries, and the percentage of particles arriving from the emitter plane at the target plane in 3 arteries, visually graded image quality in 9 arteries, and compared these quantitative and visual data between the standard scan and each acceleration scan. RESULTS 4D Flow MR imaging examinations were completed in all but one volunteer, who did not undergo the last examination because of headache. Each acceleration scan reduced scan time by 50% compared with the standard scan. The k-t SENSE imaging underestimated PSV and BFV (P < 0.05). There were significant correlations for PSV and BFV between the standard scan and each acceleration scan (P < 0.01). The percentage of particles reaching the target plane did not differ between the standard scan and each acceleration scan. For visual assessment, y-z radial sampling deteriorated the image quality of the 3 arteries. CONCLUSION Cartesian y-z radial sampling is feasible for measuring flow, and k-t SENSE offers sufficient flow visualization; both allow acquisition of 4D Flow MR imaging with shorter scan time.
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Aortopulmonary collateral flow in cystic fibrosis assessed with phase-contrast MRI. Pediatr Radiol 2013; 43:1279-86. [PMID: 23677424 PMCID: PMC3783548 DOI: 10.1007/s00247-013-2708-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/07/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a common genetic disease in Caucasians. Chronic pulmonary disease with progressive destruction of the pulmonary parenchyma is two of the major morbidities, but the relationship between clinical severity of CF and aortopulmonary collateral blood flow has not been assessed. OBJECTIVE The purpose of this study is to measure changes in aortopulmonary collateral blood flow by phase-contrast magnetic resonance imaging (MRI) in children with CF across the spectrum of disease severity as measured by the forced expiratory volume in one second as percent predicted value (FEV1% predicted). MATERIALS AND METHODS Sixteen patients with CF were prospectively evaluated. Eight were classified as having mild CF lung disease (FEV1 ≥80% predicted) and eight were classified as having moderate to severe CF lung disease (FEV1 <80% predicted). Seventeen age- and gender-matched non-CF subjects without cardiac or lung disease served as controls. Phase-contrast flow was measured at the ascending aorta, main pulmonary artery and both pulmonary arteries. Aortopulmonary collateral blood flow was calculated for each subject. The relationship between collateral flow and FEV1% predicted was modeled using nonparametric regression. Group differences were assessed by analysis of variance. RESULTS Aortopulmonary collateral blood flow began to increase as FEV1% predicted in subjects with CF fell below 101.5% with significant further increase in the aortopulmonary collateral blood flow in the subjects with CF with moderate to severe lung disease compared to controls (0.89 vs. 0.20 L/min, P < 0.0001). Aortopulmonary collateral blood flow correlated negatively with FEV1% predicted (r=0.70, P = 0.0050) confirming its relationship to this established marker of disease severity. There was no statistically significant difference in results obtained from two independent observers. CONCLUSION These preliminary findings suggest that phase-contrast MRI can be performed reliably with consistent results and without interobserver variability. While the aortopulmonary collateral blood flow is within the normal range in subjects with mild CF disease, it begins to increase even when lung function is still in the normal range. A significant increase in the aortopulmonary collateral blood flow compared to controls is measured in patients with moderate to severe CF lung disease. The studies support the notion that aortopulmonary collateral blood flow may serve as a novel and sensitive biomarker of early pulmonary disease in cystic fibrosis.
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Luchitskaya E, Deliere Q, Diedrich A, Pattyn N, Almorad A, Beck L, Gauger P, Limper U, Funtova I, Baevsky RM, Migeotte PF, Tank J. Timing and source of the maximum of the transthoracic impedance cardiogram (dZ/dt) in relation to the H-I-J complex of the longitudinal ballistocardiogram under gravity and microgravity conditions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:7294-7297. [PMID: 24111429 DOI: 10.1109/embc.2013.6611242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The transthoracic impedance cardiogram (ICG) and the acceleration ballistocardiogram (BCG) measured close to the center of mass of the human body are generated by changes of blood distribution. The transthoracic ICG is an integrated signal covering the whole thorax and spatial resolution is poor. Comparison between both signals can be used to elucidate the source of the ICG signal. We recorded the ECG, ICG, and BCG simultaneously in healthy subjects under resting and microgravity conditions during parabolic flights. The time interval between the R-peak of the ECG and the maximum of the ICG (R-dZ/dtmax) and the time interval between the R-peak of the ECG and the I-peak in the BCG (R-I) differed significantly (p<0.0001). The I-peak in the BCG always occurred earlier during systole than dZ/dtmax. The delay of dZ/dtmax ranged between 23 and 28 ms at rest and was lowest under microgravity conditions (12 ± 4 ms, p<0.02). Our results suggest that both signals have different sources. Combination of modern imaging techniques with classical non invasive approaches to detect changes of blood distribution may provide new insights into the complex interaction between blood flow and mechanocardiographic signals like the BCG.
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Hsiao A, Alley MT, Massaband P, Herfkens RJ, Chan FP, Vasanawala SS. Improved cardiovascular flow quantification with time-resolved volumetric phase-contrast MRI. Pediatr Radiol 2011; 41:711-20. [PMID: 21221566 PMCID: PMC3861881 DOI: 10.1007/s00247-010-1932-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/30/2010] [Accepted: 11/12/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiovascular flow is commonly assessed with two-dimensional, phase-contrast MRI (2-D PC-MRI). However, scan prescription and acquisition over multiple planes is lengthy, often requires direct physician oversight and has inconsistent results. Time-resolved volumetric PC-MRI (4-D flow) may address these limitations. OBJECTIVE We assess the degree of agreement and internal consistency between 2-D and 4-D flow quantification in our clinical population. MATERIALS AND METHODS Software enabling flow calculation from 4-D flow was developed in Java. With IRB approval and HIPAA compliance, 18 consecutive patients without shunts were identified who underwent both (1) conventional 2-D PC-MRI of the aorta and main pulmonary artery and (2) 4-D flow imaging. Aortic and pulmonary flow rates were assessed with both techniques. RESULTS Both methods showed general agreement in flow rates (ρ: 0.87-0.90). Systemic and pulmonary arterial flow rates were well-correlated (ρ: 4-D 0.98-0.99, 2-D 0.93), but more closely matched with 4-D (P < 0.05, Brown-Forsythe). Pulmonary flow rates were lower than systemic rates for 2-D (P < 0.05, two-sample t-test). In a sub-analysis of patients without pulmonary or aortic regurgitation, 2-D showed improved correlation of flow rates while 4-D phase-contrast remained tightly correlated (ρ: 4-D 0.99-1.00, 2-D 0.99). CONCLUSION 4-D PC-MRI demonstrates greater consistency than conventional 2-D PC-MRI for flow quantification.
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Affiliation(s)
- Albert Hsiao
- Department of Radiology, 725 Welch Road, Stanford, CA 94305-5654, USA
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Richards MS, Kripfgans OD, Rubin JM, Hall AL, Fowlkes JB. Mean volume flow estimation in pulsatile flow conditions. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1880-91. [PMID: 19819615 PMCID: PMC2783893 DOI: 10.1016/j.ultrasmedbio.2009.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 04/01/2009] [Accepted: 04/18/2009] [Indexed: 05/21/2023]
Abstract
To verify a previously reported three-dimensional (3D) ultrasound method for the measurement of time-average volumetric blood flow, experiments were performed under pulsatile flow conditions, including in vivo investigations, and results were compared with accepted, but invasive, "gold standard" techniques. Results showed that volume averaging results in the correct time-average volume flow without the need for cardiac gating. Unlike other currently employed methods, this method is independent of Doppler angle, flow profile and vessel geometry. A GE Logiq 9 ultrasound system (GE Medical Systems, Milwaukee, WI, USA) and a four-dimensional (4D) 10L and 4D 16L probe were used to acquire 3D Doppler measurements in the femoral and carotid arteries of four canines. Two invasive blood flow meters were used (electromagnetic for one canine and ultrasonic for three canines) as the gold standard techniques. Transcutaneous color flow measurements were taken to obtain 3D volume data sets encompassing the vessel. Constant depth planes were used to integrate color flow pixels encompassing the entire vessel cross-section. Power Doppler data were used to correct for partial volume effects. An artificial stenosis was induced to vary the ambient volume flow. Unrestricted, bidirectional flow was measured as high as 400 mL min(-1). Several flow restrictions were imposed that decreased the measured volumetric flow rate to as low as 30 mL min(-1). All flow rate estimates (n=38) were plotted against results obtained via the gold standards. A general line fit resulted in y = 0.926 x - 0.87 (r(2) = 0.95), which corresponds to a 0.6% flow offset relative to the average flow rate of 142 mL min(-1), as well as a 7.4% error in the linearity of our estimate. A secondary curve fit was performed that required the slope to be 1 and the intercept to be 0, which yielded an r(2)-value of 0.93. The percent-error distribution was computed and fitted to a Gaussian function, which yielded mu=-7.04% and sigma=9.52%. Theoretical studies were conducted to estimate the expected error in our volume flow measurements as a function of number of samples (N) used for averaging pulsatile waveforms. Experiments showed the same 1/N dependence as theory. Direct comparisons of volume flow rate estimates using volumetric color Doppler and independent standards showed that our method has good accuracy under in vivo pulsatile blood flow conditions.
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Affiliation(s)
| | | | | | | | - J. Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Stadlbauer A, van der Riet W, Globits S, Crelier G, Salomonowitz E. Accelerated phase-contrast MR imaging: comparison of k-t BLAST with SENSE and Doppler ultrasound for velocity and flow measurements in the aorta. J Magn Reson Imaging 2009; 29:817-24. [PMID: 19306404 DOI: 10.1002/jmri.21706] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate differences in velocity and flow measurements in the aorta between accelerated phase-contrast (PC) magnetic resonance imaging (MRI) using SENSE and k-t BLAST and in peak velocity to Doppler ultrasound. MATERIALS AND METHODS Two-dimensional PC-MRI perpendicular to the ascending and descending aorta was performed in 11 volunteers using SENSE (R = 2) and k-t BLAST (2-, 4-, 6-, and 8-fold). Peak velocity, mean velocity, and stroke volume of the accelerated PC-MRI experiments were correlated. Peak velocities were compared to Doppler ultrasound. RESULTS All acceleration techniques showed significant correlations for peak velocity with Doppler ultrasound. However, k-t BLAST 6 and 8 showed a significant underestimation. Strong correlations between SENSE and k-t BLAST were found for all three parameters. Significant differences in peak velocity were found between SENSE and all k-t BLAST experiments, but not for 2-fold k-t BLAST in the ascending aorta, and 2- and 4-fold k-t BLAST in the descending aorta. For mean velocity no significant differences were found. Stroke volume showed significant differences for all k-t BLAST experiments in the ascending and for 6- and 8-fold k-t BLAST in the descending aorta. CONCLUSION Peak velocity of accelerated PC-MRI correlated with CW Doppler measurements, but high k-t BLAST acceleration factors lead to a significant underestimation. SENSE with R = 2 and 2-fold k-t BLAST are most highly correlated in phase-contrast flow measurements.
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Affiliation(s)
- Andreas Stadlbauer
- MR Physics Group, Department of Radiology, Landesklinikum St. Poelten, Austria
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Garcia J, Kadem L, Larose E, Pibarot P. In vivo velocity and flow errors quantification by phase-contrast magnetic resonance imaging. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:1377-80. [PMID: 19162924 DOI: 10.1109/iembs.2008.4649421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance imaging is a very efficient tool for assessing velocity and flow in the cardiovascular system under normal and pathological conditions. However, this technique still has some limitations that produce different type of errors. In this study, velocities and flow were measured in vivo using phase-contrast method to determine the optimal number of phases allowing the minimization of the errors. The effect of velocity encoding upsampling was also investigated. The results showed that a number of phases between 16-24 is a good compromise to accurately estimate both ejection and regurgitant flows. Furthermore, a time shift effect caused by velocity encoding upsampling was found and a corrective linear model was proposed. These considerations may reduce flow and velocity measurement errors in normal and pathological conditions.
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Affiliation(s)
- J Garcia
- Laval Hospital Research Center, Laval University, Quebec, Canada.
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Goo HW, Al-Otay A, Grosse-Wortmann L, Wu S, Macgowan CK, Yoo SJ. Phase-contrast magnetic resonance quantification of normal pulmonary venous return. J Magn Reson Imaging 2009; 29:588-94. [DOI: 10.1002/jmri.21691] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Auger F, Beregi JP, Lions C, Negaiwi Z, Gaxotte V, Akkari K, Willoteaux S. [Contrast enhanced MR angiography: evolving towards whole-body real time acquisitions]. JOURNAL DE RADIOLOGIE 2009; 90:179-189. [PMID: 19308002 DOI: 10.1016/s0221-0363(09)72468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
MRA includes all techniques used to depict vessels with MR. Gadolinium contrast injection combined with gradient echo sequences is the technique of choice for vascular imaging. Technical advances now allow faster acquisitions. The purpose of this article is to present two main advances with MRA: whole-body MRA and dynamic 3D MRA. Technical considerations, acquisition techniques, advantages and pitfalls based on our experience with a 1.5T MR unit will be discussed in order to promote their use in routine clinical practice.
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Affiliation(s)
- F Auger
- Service d'Imagerie et de Radiologie Cardiaque et Vasculaire, Hôpital Cardiologique, CHRU de Lille, 2, avenue Oscar Lambret, 59037 Lille Cedex
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