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Chen ZH, Huang Y, Wang LP, Peng MY, Li C, Huang W. Preliminary study of hemodynamics of iliac venous compression syndrome using magnetic resonance imaging. J Vasc Surg Venous Lymphat Disord 2021; 10:131-138.e3. [PMID: 34634518 DOI: 10.1016/j.jvsv.2021.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/30/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE In clinical practice, the degree of iliac vein stenosis has often been inconsistent with the symptoms of chronic venous disease (CVD). To the best of our knowledge, no clinical studies have evaluated the hemodynamic changes associated with iliac vein stenosis. Magnetic resonance imaging (MRI) can noninvasively provide hemodynamic information. In the present study, we assessed the degree of stenosis associated with iliac venous compression syndrome and the relationships between iliac venous compression syndrome-induced, MRI-determined hemodynamic changes and lower limb symptoms. METHODS Stenosis severity, the presence of collateral vessels, and flow rate (FR) differences between the common and external iliac veins secondary to iliac vein stenosis were measured using MRI in 69 patients with CVD. Villalta scores were used as a measure of symptom severity for all patients, and the percentage of change in the Villalta score was used as a measure of symptom improvement for the patients who had received iliac vein stents. Symptom severity for all patients, a subgroup of patients with iliac vein compression (affected limbs), and a group of patients with unilateral iliac vein compression treated with stents was correlated with stenosis, differences in the external and common iliac vein FRs (<0-mL/s group, indicating stenosis-induced decreased common iliac vein flow, and ≥0-mL/s group), and stenosis-induced collateral vessel formation. RESULTS Iliac vein stenosis severity and FR differences in all affected limbs were correlated with the Villalta scores of the affected limbs (stenosis: r = 0.38, P < .001, n = 95; FR difference: r = -0.44, P < .001). In the unilateral compression subgroup, stenosis severity, FR differences, and the presence of collateral vessels were not associated with significant changes in contralateral symptoms. In the endovascular treatment subgroup, both lower limbs exhibited significant improvement after stent implantation (affected limb symptom remission, 64.6% ± 18.2%, n = 15; contralateral limb symptom remission, 49.1% ± 29.1%, n = 11). The rate of symptom remission was greater for patients with decreased iliac vein flow in the affected limbs (<0-mL/s group: 74.6% ± 16.4%, n = 7; ≥0-mL/s group: 52.2% ± 16.6%, n = 6; P = .032). CONCLUSIONS Iliac vein stenosis, the presence of collateral vessels, and decreased FRs due to stenosis correlated significantly with lower limb symptom severity. Endovascular treatment yielded good outcomes in patients with stenosis >50%. A decreased iliac venous FR could indicate a better response to stent implantation and could be used in the diagnosis and guiding decisions to treat iliac venous compression.
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Affiliation(s)
- Zi-Hui Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Yang Huang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Liang-Peng Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Ming-Yong Peng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Chao Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China
| | - Wen Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, China.
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Moersdorf R, Treutlein M, Kroeger JR, Ruijsink B, Wong J, Maintz D, Weiss K, Bunck AC, Baeßler B, Giese D. Precision, reproducibility and applicability of an undersampled multi-venc 4D flow MRI sequence for the assessment of cardiac hemodynamics. Magn Reson Imaging 2019; 61:73-82. [PMID: 31100318 DOI: 10.1016/j.mri.2019.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 03/05/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
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Park J, Kim J, Chang Y, Youn SW, Lee HJ, Kang EJ, Lee KN, Suchánek V, Hyun S, Lee J. Analysis of the time-velocity curve in phase-contrast magnetic resonance imaging: a phantom study. Comput Assist Surg (Abingdon) 2019; 24:3-12. [PMID: 31385716 DOI: 10.1080/24699322.2019.1649066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The aim of this study was to analyze the characteristics of time-velocity curve acquired by phase-contrast magnetic resonance imaging (PC-MRI) using an in-vitro flow model as a reference for hemodynamic studies. The time- velocity curves of the PC-MRI were compared with Doppler ultrasonography (US) and also compared with those obtained in the electromagnetic flowmeter. The correlation between techniques was analyzed using an electromagnetic flowmeter as a reference standard; the maximum, minimum, and average velocities, full-width at half-maximum (FWHM), and ascending gradient (AG) were measured from time-velocity curves. The correlations between an electromagnetic flowmeter and the respective measurement technique for the PC-MRI and Doppler US were found to be high (mean R2 > 0.9, p < 0.05). These results indicate that these measurement techniques are useful for measuring blood flow information and reflect actual flow. The PC-MRI was the best fit for the minimum velocity and FWHM, and the maximum velocity and AG were the best fit for Doppler US. The PC-MRI showed lower maximum velocity value and higher minimum velocity value than Doppler US. Therefore, PC-MRI demonstrates more obtuse time-velocity curve than Doppler US. In addition, the time- velocity curve of PC-MRI could be calibrated by introducing formulae that can convert each measurement value to a reference standard value within a 10% error. The PC-MRI can be used to estimate the Doppler US using this formula.
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Affiliation(s)
- Jieun Park
- Department of Biomedical Engineering, Kyungpook National University , Daegu , Republic of Korea
| | - Junghun Kim
- Department of Biomedical Engineering, Kyungpook National University , Daegu , Republic of Korea
| | - Yongmin Chang
- Department of Radiology, Kyungpook National University & Hospital , Daegu , Republic of Korea
| | - Sung Won Youn
- Department of Radiology, Catholic University of Daegu Medical Center , Daegu , Republic of Korea
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University & Hospital , Daegu , Republic of Korea
| | - Eun-Ju Kang
- Department of Radiology, Dong-A University College of Medicine , Busan , Republic of Korea
| | - Ki-Nam Lee
- Department of Radiology, Dong-A University College of Medicine , Busan , Republic of Korea
| | - Vojtěch Suchánek
- Department of Radiology, Kyungpook National University & Hospital , Daegu , Republic of Korea
| | - Sinjae Hyun
- Department of Biomedical Engineering, Mercer University , Macon , GA , USA
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University & Hospital , Daegu , Republic of Korea
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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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Frydrychowicz A, Roldan-Alzate A, Winslow E, Consigny D, Campo CA, Motosugi U, Johnson KM, Wieben O, Reeder SB. Comparison of radial 4D Flow-MRI with perivascular ultrasound to quantify blood flow in the abdomen and introduction of a porcine model of pre-hepatic portal hypertension. Eur Radiol 2017; 27:5316-5324. [PMID: 28656461 DOI: 10.1007/s00330-017-4862-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/22/2017] [Accepted: 04/20/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Objectives of this study were to compare radial time-resolved phase contrast magnetic resonance imaging (4D Flow-MRI) with perivascular ultrasound (pvUS) and to explore a porcine model of acute pre-hepatic portal hypertension (PHTN). METHODS Abdominal 4D Flow-MRI and pvUS in portal and splenic vein, hepatic and both renal arteries were performed in 13 pigs of approximately 60 kg. In six pigs, measurements were repeated after partial portal vein (PV) ligature. Inter- and intra-reader comparisons and statistical analysis including Bland-Altman (BA) comparison, paired Student's t tests and linear regression were performed. RESULTS PvUS and 4D Flow-MRI measurements agreed well; flow before partial PV ligature was 322 ± 30 ml/min in pvUS and 297 ± 27 ml/min in MRI (p = 0.294), and average BA difference was 25 ml/min [-322; 372]. Inter- and intra-reader results differed very little, revealed excellent correlation (R 2 = 0.98 and 0.99, respectively) and resulted in BA differences of -5 ml/min [-161; 150] and -2 ml/min [-28; 25], respectively. After PV ligature, PV flow decreased from 356 ± 50 to 298 ± 61 ml/min (p = 0.02), and hepatic arterial flow increased from 277 ± 36 to 331 ± 65 ml/min (p = n.s.). CONCLUSION The successful in vivo comparison of radial 4D Flow-MRI to perivascular ultrasound revealed good agreement of abdominal blood flow although with considerable spread of results. A model of pre-hepatic PHTN was successfully introduced and acute responses monitored. KEY POINTS • Radial 4D Flow-MRI in the abdomen was successfully compared to perivascular ultrasound. • Inter- and intra-reader testing demonstrated excellent reproducibility of upper abdominal 4D Flow-MRI. • A porcine model of acute pre-hepatic portal hypertension was successfully introduced. • 4D Flow-MRI successfully monitored acute changes in a model of portal hypertension.
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Affiliation(s)
- A Frydrychowicz
- Department of Radiology, School of Medicine and Public Health, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA.
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
- University of Lübeck, Lübeck, Germany.
| | - A Roldan-Alzate
- Department of Radiology, School of Medicine and Public Health, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA
- Department of Mechanical Engineering, University of Wisconsin, Madison, USA
| | - E Winslow
- Department of Surgery, University of Wisconsin, Madison, USA
| | - D Consigny
- Department of Radiology, School of Medicine and Public Health, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA
| | - C A Campo
- Department of Radiology, School of Medicine and Public Health, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA
| | - U Motosugi
- Department of Radiology, School of Medicine and Public Health, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA
| | - K M Johnson
- Department of Medical Physics, University of Wisconsin, Madison, USA
| | - O Wieben
- Department of Radiology, School of Medicine and Public Health, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA
- Department of Medical Physics, University of Wisconsin, Madison, USA
| | - S B Reeder
- Department of Radiology, School of Medicine and Public Health, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA
- Department of Medical Physics, University of Wisconsin, Madison, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA
- Department of Medicine, University of Wisconsin, Madison, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, USA
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Improved Semiautomated 4D Flow MRI Analysis in the Aorta in Patients With Congenital Aortic Valve Anomalies Versus Tricuspid Aortic Valves. J Comput Assist Tomogr 2016; 40:102-8. [PMID: 26466113 DOI: 10.1097/rct.0000000000000312] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to systematically investigate a newly developed semiautomated workflow for the analysis of aortic 4-dimensional flow MRI and its ability to detect hemodynamic differences in patients with congenitally altered aortic valve (bicuspid or quadricuspid valves) compared with tricuspid aortic valves. METHODS Four-dimensional flow MRI data were acquired in 20 patients with aortic dilatation (9 tricuspid aortic valves, 11 congenitally altered aortic valves). A semiautomated workflow was evaluated regarding interobserver variability, accuracy of net flow, regurgitant fraction and peak systolic velocity, and the ability to detect differences between cohorts. Results were compared with manual segmentation of vessel contours. RESULTS Despite the significantly reduced analysis time, a good interobserver agreement was found for net flow and peak systolic velocity, and a moderate agreement was found for regurgitation. Significant differences in peak velocities in the descending aorta (P = 0.014) could be detected. CONCLUSIONS Four-dimensional flow MRI-based semiautomated analysis of aortic hemodynamics can be performed with good reproducibility and accuracy.
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Real-time phase contrast magnetic resonance imaging for assessment of haemodynamics: from phantom to patients. Eur Radiol 2015; 26:986-96. [PMID: 26188655 DOI: 10.1007/s00330-015-3897-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 06/03/2015] [Accepted: 06/22/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Assessment of haemodynamics is crucial in many cardiac diseases. Phase contrast MRI (PC-MRI) can accurately access it. Arrhythmia is a major limitation in conventional segmented PC-MRI (SEG). A real-time PC-MRI sequence (RT) could overcome this. We validated RT by comparing to SEG. METHODS A prototype RT using shared velocity encoding was tested against SEG at 1.5 T in a flow phantom and consecutively included patients with (n = 55) or without (n = 59) aortic valve disease. In patients with atrial fibrillation (Afib, n = 15), only RT was applied. Phantom: PC images were acquired in front of and behind an interchangeable aortic-stenosis-like inlay. Mean velocity and flow were quantified. PATIENTS PC images were acquired in the ascending aorta, pulmonary trunk and superior caval vein. Peak velocity, stroke volume and regurgitant fraction were quantified. RESULTS Phantom: Mean velocities (11 ± 1 to 207 ± 10 cm/s) and flow correlated closely between SEG and RT (r ≥ 0.99, ICC ≥ 0.98, p < 0.0005). Patients without AVD or with aortic regurgitation: Concordance of SEG and RT was excellent regarding peak velocities, stroke volumes (r ≥ 0.91, ICC ≥ 0.94, p < 0.0005) and regurgitant fractions (r = 0.95, ICC = 0.95, p < 0.0005). RT was feasible in all patients with Afib. CONCLUSIONS The real-time sequence is accurate compared to conventional segmented PC-MRI. Its applicability in Afib was shown. Real-time PC-MRI might become a valuable tool in arrhythmia. KEY POINTS • Assessment of haemodynamics is crucial in many cardiac diseases. • Arrhythmias are a major limitation of conventional techniques in cardiac magnetic resonance. • A real-time technique, which allows application in arrhythmia, was validated. • This real-time technique might become a valuable tool in arrhythmic patients.
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Hinrichs J, Schaumann F, Renne J, Schönfeld C, Faulenbach C, Winkler C, Gutberlet M, Krug N, Wacker F, Hohlfeld JM, Vogel-Claussen J. Phase-contrast MRI for detection of mild systemic hemodynamic response after segmental allergen challenge in asthmatic patients. Acad Radiol 2014; 21:994-1001. [PMID: 25018071 DOI: 10.1016/j.acra.2014.03.003] [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: 01/28/2014] [Revised: 01/28/2014] [Accepted: 03/04/2014] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Detection of a systemic hemodynamic response in patients suffering from allergic asthma after segmental endobronchial allergen challenge using phase-contrast magnetic resonance imaging (MRI). MATERIALS AND METHODS Nine asthma patients and four healthy volunteers were examined using MRI (1.5T) before (0 hour), 6 hours, and 24 hours after segmental allergen challenge. Two-dimensional phase-contrast MRI measurements were performed in the aorta (AO) and in the pulmonary artery (PA). In addition, short-axis balanced steady state free precession cardiac cine MRI was performed. Maximum systolic flow, maximum flow acceleration, acceleration volume, acceleration time, distensibility, ejection fraction, stroke volume, end-systolic/diastolic volume, cardiac mass, heart rate (HR), and cardiac output (CO) were determined. Spirometry and bronchoalveolar lavage were also performed. RESULTS In patients with asthma, maximal systolic flow and maximal flow acceleration increased 6 hours after provocation in the AO (112.3% and 118.9%, respectively) and PA (113.9% and 116.0%, respectively) compared to baseline (100%, P < .05). HR and CO increased significantly at 6 hours (115% and 118%, respectively) compared to baseline (100%, P = .003). In healthy subjects, almost all MRI-derived hemodynamic parameters did not significantly change at 6 hours and were significantly lower than baseline values at 24 hours (P < .02). Twenty-four hours after allergen challenge, all MRI-derived flow parameters were significantly lower in the control group compared to the asthma group (P < .05). HR, CO, and cardiac function parameters measured at 24 hours showed no significant difference comparing the two groups (P > .05). CONCLUSIONS In asthmatic patients, MRI-derived hemodynamic parameters using phase-contrast MRI are slightly altered after segmental allergen provocation compared to normal controls indicating a mild systemic reaction to local allergen challenge.
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Affiliation(s)
- Jan Hinrichs
- Institute of Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, OE 8220, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Frank Schaumann
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Julius Renne
- Institute of Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, OE 8220, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christian Schönfeld
- Institute of Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, OE 8220, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Cornelia Faulenbach
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Christina Winkler
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Marcel Gutberlet
- Institute of Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, OE 8220, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Norbert Krug
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Frank Wacker
- Institute of Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, OE 8220, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jens M Hohlfeld
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany; Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, OE 8220, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Pieles GE, Szantho G, Rodrigues JCL, Lawton CB, Stuart AG, Bucciarelli-Ducci C, Turner MS, Williams CA, Tulloh RMR, Hamilton MCK. Adaptations of aortic and pulmonary artery flow parameters measured by phase-contrast magnetic resonance angiography during supine aerobic exercise. Eur J Appl Physiol 2014; 114:1013-23. [DOI: 10.1007/s00421-014-2833-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/23/2014] [Indexed: 11/29/2022]
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Stankovic Z, Jung B, Collins J, Russe MF, Carr J, Euringer W, Stehlin L, Csatari Z, Strohm PC, Langer M, Markl M. Reproducibility study of four-dimensional flow MRI of arterial and portal venous liver hemodynamics: influence of spatio-temporal resolution. Magn Reson Med 2013; 72:477-84. [PMID: 24018798 DOI: 10.1002/mrm.24939] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 08/01/2013] [Accepted: 08/08/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate influence of variation in spatio-temporal resolution and scan-rescan reproducibility on three-dimensional (3D) visualization and quantification of arterial and portal venous (PV) liver hemodynamics at four-dimensional (4D) flow MRI. METHODS Scan-rescan reproducibility of 3D hemodynamic analysis of the liver was evaluated in 10 healthy volunteers using 4D flow MRI at 3T with three different spatio-temporal resolutions (2.4 × 2.0 × 2.4 mm(3), 61.2 ms; 2.5 × 2.0 × 2.4 mm(3), 81.6 ms; 2.6 × 2.5 × 2.6 mm(3), 80 ms) and thus different total scan times. Qualitative flow analysis used 3D streamlines and time-resolved particle traces. Quantitative evaluation was based on maximum and mean velocities, flow volume, and vessel lumen area in the hepatic arterial and PV systems. RESULTS 4D flow MRI showed good interobserver variability for assessment of arterial and PV liver hemodynamics. 3D flow visualization revealed limitations for the left intrahepatic PV branch. Lower spatio-temporal resolution resulted in underestimation of arterial velocities (mean 15%, P < 0.05). For the PV system, hemodynamic analyses showed significant differences in the velocities for intrahepatic portal vein vessels (P < 0.05). Scan-rescan reproducibility was good except for flow volumes in the arterial system. CONCLUSION 4D flow MRI for assessment of liver hemodynamics can be performed with low interobserver variability and good reproducibility. Higher spatio-temporal resolution is necessary for complete assessment of the hepatic blood flow required for clinical applications.
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Affiliation(s)
- Zoran Stankovic
- Department of Radiology, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA; Department of Diagnostic Radiology and Medical Physics, University Medical Center Freiburg, Freiburg, Germany
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Schoennagel BP, Remus CC, Yamamura J, Kording F, Tavares de Sousa M, de Sousa MT, Hecher K, Fischer R, Ueberle F, Boehme M, Adam G, Kooijman H, Wedegaertner U. Fetal blood flow velocimetry by phase-contrast MRI using a new triggering method and comparison with Doppler ultrasound in a sheep model: a pilot study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 27:237-44. [PMID: 23934159 DOI: 10.1007/s10334-013-0397-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/09/2013] [Accepted: 07/26/2013] [Indexed: 02/03/2023]
Abstract
OBJECT We present the first study demonstrating the feasibility of antenatal blood flow velocimetry performing ECG triggered phase-contrast (PC)-MRI in the fetal aorta by using a newly developed Doppler ultrasound trigger. MATERIALS AND METHODS Five pregnant sheep carrying singleton fetuses (gestational age 121 days) were anesthetized to undergo fetal 2D PC-MRI in the fetal descending aorta (1.5 T) using a newly developed MR-compatible Doppler ultrasound trigger for fetal cardiac triggering. Inter-operator variability was assessed for PC-MR measurements and reproducibility was tested by repeated scans in one fetus. Inter-modality comparison was performed by Doppler ultrasound velocimetry. RESULTS Fetal cardiac triggering was possible in all examinations. PC-MR velocimetry revealed a mean inter-operator variability of 3 ± 5%. Average peak systolic flow velocities of 62.5 ± 4.4 cm/s were in good agreement with Doppler ultrasound measurements of 62.0 ± 9.2 cm/s (p (Lord's U test) ≫ 0.05). CONCLUSION Fetal PC-MR velocimetry was successfully performed using the newly developed MR-compatible Doppler ultrasound trigger for intrauterine fetal cardiac triggering, demonstrating high inter-operator and inter-modality agreement. This new method has the high potential for alternative assessment of hemodynamic decompensation of the fetal circulation.
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Affiliation(s)
- Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany,
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James SH, Wald R, Wintersperger BJ, Jimenez-Juan L, Deva D, Crean AM, Nguyen E, Paul NS, Ley S. Accuracy of right and left ventricular functional assessment by short-axis vs axial cine steady-state free-precession magnetic resonance imaging: intrapatient correlation with main pulmonary artery and ascending aorta phase-contrast flow measurements. Can Assoc Radiol J 2012; 64:213-9. [PMID: 22579337 DOI: 10.1016/j.carj.2011.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/11/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The left ventricle (LV) is routinely assessed with cardiac magnetic resonance imaging (MRI) by using short-axis orientation; it remains unclear whether the right ventricle (RV) can also be adequately assessed in this orientation or whether dedicated axial orientation is required. We used phase-contrast (PC) flow measurements in the main pulmonary artery (MPA) and the ascending aorta (Aorta) as nonvolumetric standard of reference and compared RV and LV volumes in short-axis and axial orientations. METHODS A retrospective analysis identified 30 patients with cardiac MRI data sets. Patients underwent MRI (1.5 T or 3 T), with retrospectively gated cine steady-state free-precession in axial and short-axis orientations. PC flow analyses of MPA and Aorta were used as the reference measure of RV and LV output. RESULTS There was a high linear correlation between MPA-PC flow and RV-stroke volume (SV) short axis (r = 0.9) and RV-SV axial (r = 0.9). Bland-Altman analysis revealed a mean offset of 1.4 mL for RV axial and -2.3 mL for RV-short-axis vs MPA-PC flow. There was a high linear correlation between Aorta-PC flow and LV-SV short-axis (r = 0.9) and LV-SV axial (r = 0.9). Bland-Altman analysis revealed a mean offset of 4.8 m for LV short axis and 7.0 mL for LV axial vs Aorta-PC flow. There was no significant difference (P = .6) between short-axis-LV SV and short-axis-RV SV. CONCLUSION No significant impact of the slice acquisition orientation for determination of RV and LV stroke volumes was found. Therefore, cardiac magnetic resonance workflow does not need to be extended by an axial data set for patients without complex cardiac disease for assessment of biventricular function and volumes.
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Affiliation(s)
- Susan H James
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Ontario, Canada
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Weber TF, von Tengg-Kobligk H, Kopp-Schneider A, Ley-Zaporozhan J, Kauczor HU, Ley S. High-resolution phase-contrast MRI of aortic and pulmonary blood flow during rest and physical exercise using a MRI compatible bicycle ergometer. Eur J Radiol 2011; 80:103-8. [DOI: 10.1016/j.ejrad.2010.06.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/22/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
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Calderon-Arnulphi M, Amin-Hanjani S, Alaraj A, Zhao M, Du X, Ruland S, Zhou XJ, Thulborn KR, Charbel FT. In vivo evaluation of quantitative MR angiography in a canine carotid artery stenosis model. AJNR Am J Neuroradiol 2011; 32:1552-9. [PMID: 21835941 DOI: 10.3174/ajnr.a2546] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Large-vessel cerebral blood flow quantification has emerged as a potential predictor of stroke risk. QMRA uses phase-contrast techniques to noninvasively measure vessel flows. To evaluate the in vivo accuracy of QMRA for measuring the effects of progressive arterial stenosis, we compared this technique with invasive flow measurements from a sonographic transit-time flow probe in a canine model. MATERIALS AND METHODS A sonographic flow probe was implanted around the CCA of hound dogs (n = 4) under general anesthesia. Pulsatile blood flow and arterial pressure were continuously recorded during CCA flow measurements with QMRA. A vascular tourniquet was applied around the CCA to produce progressive stenosis and varying flow rates. Statistical comparisons were made by using the Pearson product moment correlation coefficient. RESULTS A total of 60 paired CCA flow measurements were compared. Mean blood flows ranged between 21 and 691 mL/min during QMRA acquisition as measured by the flow probe. The correlation coefficients between flow probe and QMRA measurements for mean, maximum, and minimum volume flow rates were 0.99 (P < .0001), 0.98 (P < .0001), and 0.96 (P < .0001), respectively. The overall proportional difference between the 2 techniques was 7.8 ± 1%. Measurements at higher flow rates and in the absence of arterial stenosis had the lowest PD. CONCLUSIONS Noninvasive CCA flow measurements by using QMRA are accurate compared with invasive flow-probe measurements in a canine arterial flow model with stenosis and may be useful for the evaluation of the hemodynamic effects of stenosis caused by cerebrovascular atherosclerosis.
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Markl M, Wallis W, Harloff A. Reproducibility of flow and wall shear stress analysis using flow-sensitive four-dimensional MRI. J Magn Reson Imaging 2011; 33:988-94. [PMID: 21448968 DOI: 10.1002/jmri.22519] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To systematically investigate the scan-rescan reproducibility and observer variability of flow-sensitive four-dimensional (4D) MRI in the aorta for the assessment of blood flow and global and segmental wall shear stress. MATERIALS AND METHODS ECG and respiration-synchronized flow-sensitive 4D MRI data (spatio-temporal resolution = 1.7 × 2.0 × 2.2 mm(3) /40.8 ms) were acquired in 12 healthy volunteers. To analyze scan-rescan variability, flow-sensitive 4D MRI was repeated in 10 volunteers during a second visit. Data analysis included calculation of time-resolved and total flow, peak systolic velocity, and regional and global wall shear stress (WSS) in up to 24 analysis planes distributed along the aorta. RESULTS Scan-rescan, inter-observer, and intra-observer agreement was excellent for the calculation of total flow and peak systolic velocity (mean differences <5% of the average flow parameter). Global WSS demonstrated moderate agreement and increased variability regarding wall shear stress (scan-rescan, inter-observer, and intra-observer agreement; mean differences <10% of the average WSS parameters). The segmental distribution of wall shear stress in the thoracic aorta could reliably be reproduced (r > 0.87; P < 0.001) for different observers and examinations. CONCLUSION Flow-sensitive 4D MRI-based analysis of aortic blood flow can be performed with good reproducibility. Robustness of global and regional WSS quantification was limited, but spatio-temporal WSS distributions could reliably be replicated.
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Affiliation(s)
- Michael Markl
- Department of Radiology - Medical Physics, University Hospital Freiburg, Germany.
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Ibrahim ESH, Shaffer JM, White RD. Assessment of pulmonary artery stiffness using velocity-encoding magnetic resonance imaging: evaluation of techniques. Magn Reson Imaging 2011; 29:966-74. [PMID: 21641745 DOI: 10.1016/j.mri.2011.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 01/18/2011] [Accepted: 04/12/2011] [Indexed: 11/20/2022]
Abstract
The loss of pulmonary artery (PA) compliance has significant pathophysiological effect on the right ventricle. Noninvasive and reliable assessment of PA wall stiffness would be an essential determiner of right heart load and a clinically useful factor to assess cardiovascular risk. Two MRI techniques have been proposed for assessing PA stiffness by measuring pulse wave velocity (PWV): transit time (TT) and flow area (QA). However, no data are available that compares the two techniques and evaluates their performance, especially over a wide range of PWV values or at 3.0-T, which is the purpose of the present study. Thirty-three patients with different heart conditions were imaged using optimized high-temporal resolution and high-spatial resolution velocity-encoding MRI sequences. Statistical analysis was conducted to study intermethod, interobserver and intraobserver variabilities. The PWV measurements using TT and QA techniques showed good agreement (P>0.1). The Bland-Altman analysis showed negligible differences between the two methods (mean±S.D.=0.11±0.35 m/s, correlation coefficient r=0.94). The repeated measurements showed low interobserver and intraobserver variabilities, although the S.D. of the differences was larger in the QA technique. The mean±S.D. of the TT/QA measurement differences were -0.05±0.2/0.0±0.36 m/s and 0.02±0.26/0.02±0.39 m/s for the interobserver and intraobserver differences, respectively. In conclusion, each technique has its own advantages and disadvantages. The two techniques result in similar measurements, although the QA method is more subjective due to its dependency on operator intervention.
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Affiliation(s)
- El-Sayed H Ibrahim
- Department of Radiology, University of Florida, 655 W. 8th St., Jacksonville, FL 32209, USA.
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Ley S, Grünig E, Kiely DG, van Beek E, Wild J. Computed tomography and magnetic resonance imaging of pulmonary hypertension: Pulmonary vessels and right ventricle. J Magn Reson Imaging 2011; 32:1313-24. [PMID: 21105137 DOI: 10.1002/jmri.22373] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pulmonary hypertension (PH) is very heterogeneous and the classification identifies five major groups including many associated disease processes. The treatment of PH depends on the underlying cause and accurate classification is paramount. A comprehensive assessment to identify the cause and severity of PH is therefore needed. Furthermore, follow-up assessments are required to monitor changes in disease status and response to therapy. Traditionally, the diagnostic imaging work-up of PH comprised mainly echocardiography, invasive right heart catheterization, and ventilation/perfusion scintigraphy. Due to technical advances, multidetector row computed tomography (CT) and magnetic resonance imaging (MRI) have become important and complementary investigations in the evaluation of patients with suspected PH. Both modalities are reviewed and recommendations for clinical use are given.
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Affiliation(s)
- Sebastian Ley
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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In vitro validation of flow measurements in an aortic nitinol stent graft by velocity-encoded MRI. Eur J Radiol 2010; 80:163-7. [PMID: 20888719 DOI: 10.1016/j.ejrad.2010.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 08/26/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE To validate flow measurements within an aortic nickel-titanium (nitinol) stent graft using velocity-encoded cine magnetic resonance imaging (VEC MRI) and to assess intraobserver agreement of repeated flow measurements. MATERIALS AND METHODS An elastic tube phantom mimicking the descending aorta was developed with the possibility to insert an aortic nitinol stent graft. Different flow patterns (constant, sinusoidal and pulsatile aortic flow) were applied by a gear pump. A two-dimensional phase-contrast sequence was used to acquire VEC perpendicular cross-sections at six equidistant levels along the phantom. Each acquisition was performed twice with and without stent graft, and each dataset was analysed twice by the same reader. The percental difference of the measured flow volume to the gold standard (pump setting) was defined as the parameter for accuracy. Furthermore, the intraobserver agreement was assessed. RESULTS Mean accuracy of flow volume measurements was -0.45±1.63% without stent graft and -0.18±1.45% with stent graft. Slightly lower accuracy was obtained for aortic flow both without (-2.31%) and with (-1.29%) stent graft. Accuracy was neither influenced by the measurement position nor by repeated acquisitions. There was significant intraobserver agreement with an intraclass correlation coefficient of 0.87 (without stent graft, p<0.001) and 0.80 (with stent graft, p<0.001). The coefficient of variance was 0.25% without stent graft and 0.28% with stent graft. CONCLUSION This study demonstrated high accuracy and excellent intraobserver agreement of flow measurements within an aortic nitinol stent graft using VEC MRI. VEC MRI may give new insights into the haemodynamic consequences of endovascular aortic repair.
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EICHINGER MONIKA, WALTERSPACHER STEPHAN, SCHOLZ TOBIAS, TETZLAFF RALF, PUDERBACH MICHAEL, TETZLAFF KAY, KOPP-SCHNEIDER ANNETTE, LEY SEBASTIAN, CHOE KYUOK, KAUCZOR HANSULRICH, SORICHTER STEPHAN. Glossopharyngeal Insufflation and Pulmonary Hemodynamics in Elite Breath Hold Divers. Med Sci Sports Exerc 2010; 42:1688-95. [DOI: 10.1249/mss.0b013e3181d85dc3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tanaka H, Fujita N, Takahashi H, Sakai M, Nagao T, Murase K, Nakamura H. Effect of flip angle on volume flow measurement with nontriggered phase-contrast MR: In vivo evaluation in carotid and basilar arteries. J Magn Reson Imaging 2009; 29:1218-23. [PMID: 19388100 DOI: 10.1002/jmri.21748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effect of flip angle on volume flow rate measurements obtained with nontriggered phase-contrast magnetic resonance imaging (MRI) in vivo. MATERIALS AND METHODS We prospectively measured volume flow rates of the bilateral internal carotid artery and the basilar artery with cine and nontriggered phase-contrast MRI. For nontriggered phase-contrast imaging, flip angles of 4, 15, 60, and 90 degrees were used for 40 volunteers and of 8, 15, and 30 degrees for 54 volunteers. Lumen boundaries were semiautomatically determined by pulsatility-based segmentation using cine phase-contrast MRI. Identical lumen boundaries were used for nontriggered phase-contrast imaging. RESULTS The ratio of volume flow rate obtained with nontriggered phase-contrast imaging to that obtained with cine phase-contrast imaging significantly increases with an increase in the flip angle. The mean ratios lie within a relatively narrow range of +/-15% with a wide range of flip angles of 8-90 degrees . As the flip angle increases, ghost artifacts become prominent and signal-to-noise and contrast-to-noise ratios increase. CONCLUSION Flip angles between 8 and 60 degrees are most appropriate for nontriggered phase-contrast MR measurements in the internal carotid and the basilar artery.
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Affiliation(s)
- Hisashi Tanaka
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Abstract
Current advances in magnetic resonance, as a diagnostic modality, are discussed in the context of publications from Investigative Radiology during 2007 and 2008. The articles relating to this topic, published during the past 2 years, are reviewed by anatomic region. The discussion concludes with a consideration of magnetic resonance contrast media, focusing on studies published in the journal, and examining in particular the potential impact of nephrogenic systemic fibrosis.
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