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Wang M, Ma Y, Li L, Pan X, Wen Y, Qiu Y, Guo D, Zhu Y, Lian J, Tong D. Compressed Sensitivity Encoding Artificial Intelligence Accelerates Brain Metastasis Imaging by Optimizing Image Quality and Reducing Scan Time. AJNR Am J Neuroradiol 2024; 45:444-452. [PMID: 38485196 DOI: 10.3174/ajnr.a8161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/25/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE Accelerating the image acquisition speed of MR imaging without compromising the image quality is challenging. This study aimed to evaluate the feasibility of contrast-enhanced (CE) 3D T1WI and CE 3D-FLAIR sequences reconstructed with compressed sensitivity encoding artificial intelligence (CS-AI) for detecting brain metastases (BM) and explore the optimal acceleration factor (AF) for clinical BM imaging. MATERIALS AND METHODS Fifty-one patients with cancer with suspected BM were included. Fifty participants underwent different customized CE 3D-T1WI or CE 3D-FLAIR sequence scans. Compressed SENSE encoding acceleration 6 (CS6), a commercially available standard sequence, was used as the reference standard. Quantitative and qualitative methods were used to evaluate image quality. The SNR and contrast-to-noise ratio (CNR) were calculated, and qualitative evaluations were independently conducted by 2 neuroradiologists. After exploring the optimal AF, sample images were obtained from 1 patient by using both optimized sequences. RESULTS Quantitatively, the CNR of the CS-AI protocol for CE 3D-T1WI and CE 3D-FLAIR sequences was superior to that of the CS protocol under the same AF (P < .05). Compared with reference CS6, the CS-AI groups had higher CNR values (all P < .05), with the CS-AI10 scan having the highest value. The SNR of the CS-AI group was better than that of the reference for both CE 3D-T1WI and CE 3D-FLAIR sequences (all P < .05). Qualitatively, the CS-AI protocol produced higher image quality scores than did the CS protocol with the same AF (all P < .05). In contrast to the reference CS6, the CS-AI group showed good image quality scores until an AF of up to 10 (all P < .05). The CS-AI10 scan provided the optimal images, improving the delineation of normal gray-white matter boundaries and lesion areas (P < .05). Compared with the reference, CS-AI10 showed reductions in scan time of 39.25% and 39.93% for CE 3D-T1WI and CE 3D-FLAIR sequences, respectively. CONCLUSIONS CE 3D-T1WI and CE 3D-FLAIR sequences reconstructed with CS-AI for the detection of BM may provide a more effective alternative reconstruction approach than CS. CS-AI10 is suitable for clinical applications, providing optimal image quality and a shortened scan time.
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Affiliation(s)
- Mengmeng Wang
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Yue Ma
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Linna Li
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Xingchen Pan
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Yafei Wen
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Ying Qiu
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Dandan Guo
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
| | - Yi Zhu
- Philips Healthcare (Y.Z., J.L., D.T.), Beijing, China
| | - Jianxiu Lian
- Philips Healthcare (Y.Z., J.L., D.T.), Beijing, China
| | - Dan Tong
- From the Department of Radiology (M.W., Y.M., L.L., X.P., Y.W., Y.Q., D.G., D.T.), The First Hospital of Jilin University, Changchun, China
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Sodhi A, Markl M, Popescu AR, Griffin LM, Robinson JD, Rigsby CK. Highly accelerated compressed sensing 4D flow MRI in congenital and acquired heart disease: comparison of aorta and main pulmonary artery flow parameters with conventional 4D flow MRI in children and young adults. Pediatr Radiol 2023; 53:2597-2607. [PMID: 37882844 DOI: 10.1007/s00247-023-05788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Four-dimensional flow (4D flow) MRI has become a clinically utilized cardiovascular flow assessment tool. However, scans can be lengthy and may require anesthesia in younger children. Adding compressed sensing can decrease scan time, but its impact on hemodynamic data accuracy needs additional assessment. OBJECTIVE To compare 4D flow hemodynamics acquired with and without compressed sensing. MATERIALS AND METHODS Twenty-seven patients (median age: 13 [IQR: 9.5] years) underwent conventional and compressed sensing cardiovascular 4D flow following informed consent. Conventional 4D flow was performed using parallel imaging and an acceleration factor of 2. Compressed sensing 4D flow was performed with an acceleration factor of 7.7. Regions of interest were placed to compare flow parameters in the ascending aorta and main pulmonary artery. Paired Student's t-tests, Wilcoxon signed-rank tests, Bland-Altman plots, and intraclass correlation coefficients were conducted. A P-value of < 0.05 was considered statistically significant. RESULTS Mean scan acquisition time was reduced by 59% using compressed sensing (3.4 vs. 8.2 min, P < 0.001). Flow quantification was similar for compressed sensing and conventional 4D flow for the ascending aorta net flow: 47 vs. 49 ml/beat (P = 0.28); forward flow: 49 vs. 50 ml/beat (P = 0.07), and main pulmonary artery net flow: 49 vs. 51 ml/beat (P = 0.18); forward flow: 50 vs. 55 ml/beat (P = 0.07). Peak systolic velocity was significantly underestimated by compressed sensing 4D flow in the ascending aorta: 114 vs. 128 cm/s (P < 0.001) and main pulmonary artery: 106 vs. 112 cm/s (P = 0.02). CONCLUSION For both the aorta and main pulmonary artery, compressed sensing 4D flow provided equivalent net and forward flow values compared to conventional 4D flow but underestimated peak systolic velocity. By reducing scan time, compressed sensing 4D flow may decrease the need for anesthesia and increase scanner output without significantly compromising data integrity.
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Affiliation(s)
- Aparna Sodhi
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA.
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL, USA
| | - Andrada R Popescu
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lindsay M Griffin
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua D Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Wieben O, Roberts GS, Corrado PA, Johnson KM, Roldán-Alzate A. Four-Dimensional Flow MR Imaging: Technique and Advances. Magn Reson Imaging Clin N Am 2023; 31:433-449. [PMID: 37414470 DOI: 10.1016/j.mric.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
4D Flow MRI is an advanced imaging technique for comprehensive non-invasive assessment of the cardiovascular system. The capture of the blood velocity vector field throughout the cardiac cycle enables measures of flow, pulse wave velocity, kinetic energy, wall shear stress, and more. Advances in hardware, MRI data acquisition and reconstruction methodology allow for clinically feasible scan times. The availability of 4D Flow analysis packages allows for more widespread use in research and the clinic and will facilitate much needed multi-center, multi-vendor studies in order to establish consistency across scanner platforms and to enable larger scale studies to demonstrate clinical value.
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Affiliation(s)
- Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA.
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705-2275, USA
| | - Philip A Corrado
- Accuray Incorporated, 1414 Raleigh Road, Suite 330, DurhamChapel Hill, NC 27517, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Room: 3035, 1513 University Avenue, Madison, WI 53706, USA; Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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Soulat G, Alattar Y, Ladouceur M, Craiem D, Pascaner A, Gencer U, Malekzadeh-Milani S, Iserin L, Karsenty C, Mousseaux E. Discordance between 2D and 4D flow in the assessment of pulmonary regurgitation severity: a right ventricular remodeling follow-up study. Eur Radiol 2023; 33:5455-5464. [PMID: 36905468 DOI: 10.1007/s00330-023-09502-6] [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: 08/12/2022] [Revised: 12/06/2022] [Accepted: 02/06/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES Pulmonary regurgitation (PR) is common in adult congenital heart disease (ACHD). 2D phase contrast MRI is the reference method for the quantification of PR and helps in the decision of pulmonary valve replacement (PVR). 4D flow MRI can be an alternative method to estimate PR but more validation is still needed. Our purpose was to compare 2D and 4D flow in PR quantification using the degree of right ventricular remodeling after PVR as the reference standard. METHODS In 30 adult patients with a pulmonary valve disease recruited between 2015 and 2018, PR was assessed using both 2D and 4D flow. Based on the clinical standard of care, 22 underwent PVR. The pre PVR estimate of PR was compared using the post-operative decrease in right ventricle end-diastolic volume on follow-up exam as reference. RESULTS In the overall cohort, regurgitant volume (Rvol) and regurgitant fraction (RF) of PR measured by 2D and 4D flow were well correlated but with moderate agreement in the overall cohort (r = 0.90, mean diff. -14 ± 12.5 mL; and r = 0.72, mean diff. -15 ± 13%; all p < 0.0001). Correlations between Rvol estimates and right ventricle end-diastolic volume decrease after PVR was higher with 4D flow (r = 0.80, p < 0.0001) than with 2D flow (r = 0.72, p < 0.0001). CONCLUSIONS In ACHD, PR quantification from 4D flow better predicts post-PVR right ventricle remodeling than that from 2D flow. Further studies are needed to evaluate the added value of this 4D flow quantification for guiding replacement decision. KEY POINTS • Using 4D flow MRI allows a better quantification of pulmonary regurgitation in adult congenital heart disease than 2D flow when taking right ventricle remodeling after pulmonary valve replacement as a reference. • A plane positioned perpendicular to the ejected flow volume as allowed by 4D flow provides better results to estimate pulmonary regurgitation.
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Affiliation(s)
- Gilles Soulat
- Université Paris cité, PARCC (Paris-Cardiovascular Research Center), INSERM 970, 20 rue Leblanc, F-75015, Paris, France.
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France.
| | - Yousef Alattar
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Magalie Ladouceur
- Université Paris cité, PARCC (Paris-Cardiovascular Research Center), INSERM 970, 20 rue Leblanc, F-75015, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Ariel Pascaner
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Umit Gencer
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Sophie Malekzadeh-Milani
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Laurence Iserin
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Clement Karsenty
- Université Paris cité, PARCC (Paris-Cardiovascular Research Center), INSERM 970, 20 rue Leblanc, F-75015, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Elie Mousseaux
- Université Paris cité, PARCC (Paris-Cardiovascular Research Center), INSERM 970, 20 rue Leblanc, F-75015, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
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Bissell MM, Raimondi F, Ait Ali L, Allen BD, Barker AJ, Bolger A, Burris N, Carhäll CJ, Collins JD, Ebbers T, Francois CJ, Frydrychowicz A, Garg P, Geiger J, Ha H, Hennemuth A, Hope MD, Hsiao A, Johnson K, Kozerke S, Ma LE, Markl M, Martins D, Messina M, Oechtering TH, van Ooij P, Rigsby C, Rodriguez-Palomares J, Roest AAW, Roldán-Alzate A, Schnell S, Sotelo J, Stuber M, Syed AB, Töger J, van der Geest R, Westenberg J, Zhong L, Zhong Y, Wieben O, Dyverfeldt P. 4D Flow cardiovascular magnetic resonance consensus statement: 2023 update. J Cardiovasc Magn Reson 2023; 25:40. [PMID: 37474977 PMCID: PMC10357639 DOI: 10.1186/s12968-023-00942-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.
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Affiliation(s)
- Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9NL, UK.
| | | | - Lamia Ait Ali
- Institute of Clinical Physiology CNR, Massa, Italy
- Foundation CNR Tuscany Region G. Monasterio, Massa, Italy
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, USA
| | - Ann Bolger
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nicholas Burris
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Carl-Johan Carhäll
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Albert Hsiao
- Department of Radiology, University of California, San Diego, CA, USA
| | - Kevin Johnson
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Liliana E Ma
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duarte Martins
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Marci Messina
- Department of Radiology, Northwestern Medicine, Chicago, IL, USA
| | - Thekla H Oechtering
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck and Universität Zu Lübeck, Lübeck, Germany
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Pim van Ooij
- Department of Radiology & Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cynthia Rigsby
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jose Rodriguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d´Hebron,Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red-CV, CIBER CV, Madrid, Spain
| | - Arno A W Roest
- Department of Pediatric Cardiology, Willem-Alexander's Children Hospital, Leiden University Medical Center and Center for Congenital Heart Defects Amsterdam-Leiden, Leiden, The Netherlands
| | | | - Susanne Schnell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Physics, Institute of Physics, University of Greifswald, Greifswald, Germany
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering - iHEALTH, Santiago, Chile
| | - Matthias Stuber
- Département de Radiologie Médicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ali B Syed
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rob van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Westenberg
- CardioVascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Zhong
- National Heart Centre Singapore, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yumin Zhong
- Department of Radiology, School of Medicine, Shanghai Children's Medical Center Affiliated With Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Oliver Wieben
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Petter Dyverfeldt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Kilinc O, Chu S, Baraboo J, Weiss EK, Engel J, Maroun A, Giese D, Jin N, Chow K, Bi X, Davids R, Mehta C, Malaisrie SC, Hoel A, Carr J, Markl M, Allen BD. Hemodynamic Evaluation of Type B Aortic Dissection Using Compressed Sensing Accelerated 4D Flow MRI. J Magn Reson Imaging 2023; 57:1752-1763. [PMID: 36148924 PMCID: PMC10033465 DOI: 10.1002/jmri.28432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND 4D Flow MRI is a quantitative imaging technique to evaluate blood flow patterns; however, it is unclear how compressed sensing (CS) acceleration would impact aortic hemodynamic quantification in type B aortic dissection (TBAD). PURPOSE To investigate CS-accelerated 4D Flow MRI performance compared to GRAPP-accelerated 4D Flow MRI (GRAPPA) to evaluate aortic hemodynamics in TBAD. STUDY TYPE Prospective. POPULATION Twelve TBAD patients, two volunteers. FIELD STRENGTH/SEQUENCE 1.5T, 3D time-resolved cine phase-contrast gradient echo sequence. ASSESSMENT GRAPPA (acceleration factor [R] = 2) and two CS-accelerated (R = 7.7 [CS7.7] and 10.2 [CS10.2]) 4D Flow MRI scans were acquired twice for interscan reproducibility assessment. Voxelwise kinetic energy (KE), peak velocity (PV), forward flow (FF), reverse flow (RF), and stasis were calculated. Plane-based mid-lumen flows were quantified. Imaging times were recorded. TESTS Repeated measures analysis of variance, Pearson correlation coefficients (r), intraclass correlation coefficients (ICC). P < 0.05 indicated statistical significance. RESULTS The KE and FF in true lumen (TL) and PV in false lumen (FL) did not show difference among three acquisition types (P = 0.818, 0.065, 0.284 respectively). The PV and stasis in TL were higher, KE, FF, and RF in FL were lower, and stasis was higher in GRAPPA compared to CS7.7 and CS10.2. The RF was lower in GRAPPA compared to CS10.2. The correlation coefficients were strong in TL (r = [0.781-0.986]), and low to strong in FL (r = [0.347-0.948]). The ICC levels demonstrated moderate to excellent interscan reproducibility (0.732-0.989). The FF and net flow in mid-descending aorta TL were significantly different between CS7.7 and CS10.2. CONCLUSION CS-accelerated 4D Flow MRI has potential for clinical utilization with shorter scan times in TBAD. Our results suggest similar hemodynamic trends between acceleration types, but CS-acceleration impacts KE, FF, RF, and stasis more in FL. EVIDENCE LEVEL 1 Technical Efficacy: Stage 2.
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Affiliation(s)
- Ozden Kilinc
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Stanley Chu
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Justin Baraboo
- Department of Radiology, Northwestern University, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Elizabeth K. Weiss
- Department of Radiology, Northwestern University, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Joshua Engel
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Anthony Maroun
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Cleveland, Ohio
| | - Kelvin Chow
- Department of Radiology, Northwestern University, Chicago, Illinois
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Xiaoming Bi
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Rachel Davids
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Christopher Mehta
- Department of Surgery (Cardiac Surgery), Northwestern University, Chicago, Illinois
| | | | - Andrew Hoel
- Department of Surgery (Vascular Surgery), Northwestern University, Chicago, Illinois
| | - James Carr
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Bradley D. Allen
- Department of Radiology, Northwestern University, Chicago, Illinois
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7
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Kim D, Jen ML, Eisenmenger LB, Johnson KM. Accelerated 4D-flow MRI with 3-point encoding enabled by machine learning. Magn Reson Med 2023; 89:800-811. [PMID: 36198027 PMCID: PMC9712238 DOI: 10.1002/mrm.29469] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the acceleration of 4D-flow MRI using a convolutional neural network (CNN) that produces three directional velocities from three flow encodings, without requiring a fourth reference scan measuring background phase. METHODS A fully 3D CNN using a U-net architecture was trained in a block-wise fashion to take complex images from three flow encodings and to produce three real-valued images for each velocity component. Using neurovascular 4D-flow scans (n = 144), the CNN was trained to predict velocities computed from four flow encodings by standard reconstruction including correction for residual background phase offsets. Methods to optimize loss functions were investigated, including magnitude, complex difference, and uniform velocity weightings. Subsequently, 3-point encoding was evaluated using cross validation of pixelwise correlation, flow measurements in major arteries, and in experiments with data at differing acceleration rates than the training data. RESULTS The CNN-produced 3-point velocities showed excellent agreements with the 4-point velocities, both qualitatively in velocity images, in flow rate measures, and quantitatively in regression analysis (slope = 0.96, R2 = 0.992). Optimizing the training to focus on vessel velocities rather than the global velocity error and improved the correlation of velocity within vessels themselves. The lowest error was observed when the loss function used uniform velocity weighting, in which the magnitude-weighted inverse of the velocity frequency uniformly distributed weighting across all velocity ranges. When applied to highly accelerated data, the 3-point network maintained a high correlation with ground truth data and demonstrated a denoising effect. CONCLUSION The 4D-flow MRI can be accelerated using machine learning requiring only three flow encodings to produce three-directional velocity maps with small errors.
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Affiliation(s)
- Dahan Kim
- Department of Physics, University of Wisconsin, Madison, Wisconsin, USA,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mu-Lan Jen
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura B. Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin M. Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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8
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Li P, Lennartz S, Consul N, Moy L, Lee SI. Top Covers of the Centennial. Radiology 2023; 306:64-68. [PMID: 36534609 DOI: 10.1148/radiol.229033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Peter Li
- From the Department of Radiology, Oregon Health and Science University Hospital Dotter Interventional Institute, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239 (P.L.); Institute for Diagnostic and Interventional Radiology, University of Cologne, Germany (S.L.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.C, S.I.L.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.)
| | - Simon Lennartz
- From the Department of Radiology, Oregon Health and Science University Hospital Dotter Interventional Institute, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239 (P.L.); Institute for Diagnostic and Interventional Radiology, University of Cologne, Germany (S.L.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.C, S.I.L.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.)
| | - Nikita Consul
- From the Department of Radiology, Oregon Health and Science University Hospital Dotter Interventional Institute, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239 (P.L.); Institute for Diagnostic and Interventional Radiology, University of Cologne, Germany (S.L.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.C, S.I.L.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, Oregon Health and Science University Hospital Dotter Interventional Institute, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239 (P.L.); Institute for Diagnostic and Interventional Radiology, University of Cologne, Germany (S.L.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.C, S.I.L.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.)
| | - Susanna I Lee
- From the Department of Radiology, Oregon Health and Science University Hospital Dotter Interventional Institute, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239 (P.L.); Institute for Diagnostic and Interventional Radiology, University of Cologne, Germany (S.L.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.C, S.I.L.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.)
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9
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Kumar P, Bhatia M, Arora N. Computed Tomographic Evaluation of Congenital Left Ventricular Outflow Obstruction. Curr Cardiol Rev 2023; 19:31-49. [PMID: 37231752 PMCID: PMC10636799 DOI: 10.2174/1573403x19666230525144602] [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: 08/29/2022] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Congenital left ventricular outflow obstruction represents a multilevel obstruction with several morphological forms. It can involve the subvalvular, valvar, or supravalvular portion of the aortic valve complex, and may coexist. Computed tomography (CT) plays an important supplementary role in the evaluation of patients with congenital LVOT obstruction. Unlike transthoracic echocardiography and cardiovascular magnetic resonance (CMR) imaging, it is not bounded by a small acoustic window, needs for anaesthesia or sedation, and metallic devices. Current generations of CT scanners with excellent spatial and temporal resolution, high pitch scanning, wide detector system, dose reduction algorithms, and advanced 3-dimensional postprocessing techniques provide a high-quality alternative to CMR or diagnostic cardiac catheterization. Radiologists performing CT in young children should be familiar with the advantages and disadvantages of CT and with the typical morphological imaging features of congenital left ventricular outflow obstruction.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
- Convener, Cardiac Imaging, Cardiological Society of India, Kolkata, 700054, India
| | - Natisha Arora
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
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10
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Varga-Szemes A, Halfmann M, Schoepf UJ, Jin N, Kilburg A, Dargis DM, Düber C, Ese A, Aquino G, Xiong F, Kreitner KF, Markl M, Emrich T. Highly Accelerated Compressed-Sensing 4D Flow for Intracardiac Flow Assessment. J Magn Reson Imaging 2022. [PMID: 36264176 DOI: 10.1002/jmri.28484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Four-dimensional (4D) flow MRI allows for the quantification of complex flow patterns; however, its clinical use is limited by its inherently long acquisition time. Compressed sensing (CS) is an acceleration technique that provides substantial reduction in acquisition time. PURPOSE To compare intracardiac flow measurements between conventional and CS-based highly accelerated 4D flow acquisitions. STUDY TYPE Prospective. SUBJECTS Fifty healthy volunteers (28.0 ± 7.1 years, 24 males). FIELD STRENGTH/SEQUENCE Whole heart time-resolved 3D gradient echo with three-directional velocity encoding (4D flow) with conventional parallel imaging (factor 3) as well as CS (factor 7.7) acceleration at 3 T. ASSESSMENT 4D flow MRI data were postprocessed by applying a valve tracking algorithm. Acquisition times, flow volumes (mL/cycle) and diastolic function parameters (ratio of early to late diastolic left ventricular peak velocities [E/A] and ratio of early mitral inflow velocity to mitral annular early diastolic velocity [E/e']) were quantified by two readers. STATISTICAL TESTS Paired-samples t-test and Wilcoxon rank sum test to compare measurements. Pearson correlation coefficient (r), Bland-Altman-analysis (BA) and intraclass correlation coefficient (ICC) to evaluate agreement between techniques and readers. A P value < 0.05 was considered statistically significant. RESULTS A significant improvement in acquisition time was observed using CS vs. conventional accelerated acquisition (6.7 ± 1.3 vs. 12.0 ± 1.3 min). Net forward flow measurements for all valves showed good correlation (r > 0.81) and agreement (ICCs > 0.89) between conventional and CS acceleration, with 3.3%-8.3% underestimation by the CS technique. Evaluation of diastolic function showed 3.2%-17.6% error: E/A 2.2 [1.9-2.4] (conventional) vs. 2.3 [2.0-2.6] (CS), BA bias 0.08 [-0.81-0.96], ICC 0.82; and E/e' 4.6 [3.9-5.4] (conventional) vs. 3.8 [3.4-4.3] (CS), BA bias -0.90 [-2.31-0.50], ICC 0.89. DATA CONCLUSION Analysis of intracardiac flow patterns and evaluation of diastolic function using a highly accelerated 4D flow sequence prototype is feasible, but it shows underestimation of flow measurements by approximately 10%. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Ning Jin
- Siemens Medical Solutions USA Inc., Chicago, Illinois, USA
| | - Anton Kilburg
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Danielle M Dargis
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Amir Ese
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Gilberto Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Fei Xiong
- Siemens Medical Solutions USA Inc., Chicago, Illinois, USA
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
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11
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Adabifirouzjaei F, Hsiao A, DeMaria AN. Mitral Valve Prolapse-The Role of Cardiac Imaging Modalities. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100024. [PMID: 37273735 PMCID: PMC10236887 DOI: 10.1016/j.shj.2022.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 06/06/2023]
Abstract
Mitral valve prolapse (MVP) is the most common nonischemic mitral regurgitation etiology and mitral abnormality requiring surgery in the Western world. There is an increasing awareness that pathological findings in MVP are not confined to the valve tissue; rather, it is a complex disease, involving the mitral valve apparatus, cardiac hemodynamics, and cardiac structure. Imaging has played a fundamental role in the understanding of the diagnosis, prevalence, and consequences of MVP. The diagnosis of MVP by imaging is based upon demonstrating valve leaflets ascending into the left atrium through the saddle-shaped annulus. Transthoracic and transesophageal echocardiography are the primary modalities in the diagnosis and assessment of MVP patients and must include careful assessment of the leaflets, annulus, chords, and papillary muscles. High-spatial-resolution imaging modalities such as cardiac magnetic resonance images and cardiac computed tomography play a secondary role in this regard and can demonstrate the anatomical relation between the mitral valve annulus and leaflet excursion for appropriate diagnosis. Ongoing development of new methods of cardiac imaging can help us to accurately understand the mechanism, diagnose the disease, develop an appropriate treatment plan, and estimate the risk for sudden death. Recently, several new observations with respect to prolapse have been derived from cardiac imaging including three-dimensional echocardiography and tissue-Doppler imaging. The aim of this article is to present these new imaging-derived insights for the diagnosis, risk assessment, treatment, and follow-up of patients with MVP.
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Affiliation(s)
- Fatemeh Adabifirouzjaei
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Albert Hsiao
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Anthony N. DeMaria
- Department of Cardiology, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
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12
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Raimondi F, Martins D, Coenen R, Panaioli E, Khraiche D, Boddaert N, Bonnet D, Atkins M, El-Said H, Alshawabkeh L, Hsiao A. Prevalence of Venovenous Shunting and High-Output State Quantified with 4D Flow MRI in Patients with Fontan Circulation. Radiol Cardiothorac Imaging 2021; 3:e210161. [PMID: 34934948 PMCID: PMC8686005 DOI: 10.1148/ryct.210161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the ability of four-dimensional (4D) flow MRI to quantify flow volume of the Fontan circuit, including the frequency and hemodynamic contribution of systemic-to-pulmonary venovenous collateral vessels. MATERIALS AND METHODS In this retrospective study, patients with Fontan circulation were included from three institutions (2017-2021). Flow measurements were performed at several locations along the circuit by two readers, and collateral shunt volumes were quantified. The frequency of venovenous collaterals and structural defects were tabulated from concurrent MR angiography, contemporaneous CT, or catheter angiography and related to Fontan clinical status. Statistical analysis included Pearson and Spearman correlation and Bland-Altman analysis. RESULTS Seventy-five patients (mean age, 20 years; range, 5-58 years; 46 female and 29 male patients) were included. Interobserver agreement was high for aortic output, pulmonary arteries, pulmonary veins, superior vena cava (Glenn shunt), and inferior vena cava (Fontan conduit) (range, ρ = 0.913-0.975). Calculated shunt volume also showed strong agreement, on the basis of the difference between aortic and pulmonary flow (ρ = 0.935). A total of 37 of 75 (49%) of the patients exhibited shunts exceeding 1.00 L/min, 81% (30 of 37) of whom had pulmonary venous or atrial flow volume step-ups and corresponding venovenous collaterals. A total of 12% of patients (nine of 75) exhibited a high-output state (>4 L/min/m2), most of whom had venovenous shunts exceeding 30% of cardiac output. CONCLUSION Fontan flow and venovenous shunting can be reliably quantified at 4D flow MRI; high-output states were found in a higher proportion of patients than expected, among whom venovenous collaterals were common and constituted a substantial proportion of cardiac output.Keywords: Pediatrics, MR Angiography, Cardiac, Technology Assessment, Hemodynamics/Flow Dynamics, Congenital Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Francesca Raimondi
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Duarte Martins
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Raluca Coenen
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Elena Panaioli
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Diala Khraiche
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Nathalie Boddaert
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Damien Bonnet
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Melany Atkins
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Howaida El-Said
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Laith Alshawabkeh
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
| | - Albert Hsiao
- From the Unité Médico-Chirurgicale de Cardiologie
Congénitale et Pédiatrique, Centre de Référence des
Maladies Cardiaques Congénitales Complexes-M3C, Hôpital
Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
(F.R., D.K., D.B.); Pediatric Radiology Unit, Hôpital Universitaire
Necker-Enfants Malades, Université de Paris, Paris, France (F.R., E.P.,
N.B.); Decision and Bayesian Computation, Computation Biology Department, CNRS,
URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris,
France (F.R.); School of Biomedical Engineering & Imaging Sciences,
King’s College London, Lambeth Wing, St Thomas’ Hospital, London,
England (F.R.); Department of Pediatric Cardiology, Hospital de Santa Cruz,
Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (D.M.); Radiology and
Cardiology Unit, Erasmus MC, Rotterdam, the Netherlands (R.C.); Fairfax
Radiological Consultants, Fairfax, Va (M.A.); and Departments of Pediatric
Cardiology (H.E.S.), Cardiovascular Medicine (L.A.), and Radiology (A.H.),
University of California, San Diego, 9300 Campus Point Dr, Room 7756, La Jolla,
CA 92037-7756
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13
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Abstract
PURPOSE OF REVIEW Discuss foundational concepts for artificial intelligence (AI) and review recent literature on its application to aortic disease. RECENT FINDINGS Machine learning (ML) techniques are rapidly evolving for the evaluation of aortic disease - broadly categorized as algorithms for aortic segmentation, detection of pathology, and risk stratification. Advances in deep learning, particularly U-Net architectures, have revolutionized segmentation of the aorta and show potential for monitoring the size of aortic aneurysm and characterizing aortic dissection. These algorithms also facilitate application of more complex technologies including analysis of flow dynamics with 4D Flow magnetic resonance imaging (MRI) and computational simulation of fluid dynamics for aortic coarctation. In addition, AI algorithms have been proposed to assist in 'opportunistic' screening from routine imaging exams, including automated aortic calcification score, which has emerged as a strong predictor of cardiovascular risk. Finally, several ML algorithms are being explored for risk stratification of patients with aortic aneurysm and dissection, in addition to prediction of postprocedural complications. SUMMARY Multiple ML techniques have potential for characterization and risk prediction of aortic aneurysm, dissection, coarctation, and atherosclerotic disease on computed tomography and MRI. This nascent field shows considerable promise with many applications in development and in early preclinical evaluation.
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14
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Abstract
MRI is an essential diagnostic tool in the anatomic and functional evaluation of cardiovascular disease. In many practices, 2D phase-contrast (2D-PC) has been used for blood flow quantification. 4D Flow MRI is a time-resolved volumetric acquisition that captures the vector field of blood flow along with anatomic images. 4D Flow MRI provides a simpler acquisition compared to 2D-PC and facilitates a more accurate and comprehensive hemodynamic assessment. Advancements in accelerated imaging have significantly shortened scan times of 4D Flow MRI while preserving image quality, enabling this technology to transition from the research arena to routine clinical practice. In this article, we review technical optimization based on our clinical experience of over 10 years with 4D Flow MRI. We also present pearls and pitfalls in the practical application of 4D Flow MRI, including how to quantify cardiovascular shunts, valvular or vascular stenosis, and valvular regurgitation. As experience increases, and as 4D Flow sequences and post-processing software become more broadly available, 4D Flow MRI will likely become an essential component of cardiac imaging for practices involved in the management of congenital and acquired structural heart disease.
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15
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Elsayed A, Gilbert K, Scadeng M, Cowan BR, Pushparajah K, Young AA. Four-dimensional flow cardiovascular magnetic resonance in tetralogy of Fallot: a systematic review. J Cardiovasc Magn Reson 2021; 23:59. [PMID: 34011372 PMCID: PMC8136126 DOI: 10.1186/s12968-021-00745-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with repaired Tetralogy of Fallot (rTOF) often develop cardiovascular dysfunction and require regular imaging to evaluate deterioration and time interventions such as pulmonary valve replacement. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) enables detailed assessment of flow characteristics in all chambers and great vessels. We performed a systematic review of intra-cardiac 4D flow applications in rTOF patients, to examine clinical utility and highlight optimal methods for evaluating rTOF patients. METHODS A comprehensive literature search was undertaken in March 2020 on Google Scholar and Scopus. A modified version of the Critical Appraisal Skills Programme (CASP) tool was used to assess and score the applicability of each study. Important clinical outcomes were assessed including similarities and differences. RESULTS Of the 635 articles identified, 26 studies met eligibility for systematic review. None of these were below 59% applicability on the modified CASP score. Studies could be broadly classified into four groups: (i) pilot studies, (ii) development of new acquisition methods, (iii) validation and (vi) identification of novel flow features. Quantitative comparison with other modalities included 2D phase contrast CMR (13 studies) and echocardiography (4 studies). The 4D flow study applications included stroke volume (18/26;69%), regurgitant fraction (16/26;62%), relative branch pulmonary artery flow(4/26;15%), systolic peak velocity (9/26;35%), systemic/pulmonary total flow ratio (6/26;23%), end diastolic and end systolic volume (5/26;19%), kinetic energy (5/26;19%) and vorticity (2/26;8%). CONCLUSIONS 4D flow CMR shows potential in rTOF assessment, particularly in retrospective valve tracking for flow evaluation, velocity profiling, intra-cardiac kinetic energy quantification, and vortex visualization. Protocols should be targeted to pathology. Prospective, randomized, multi-centered studies are required to validate these new characteristics and establish their clinical use.
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Affiliation(s)
- Ayah Elsayed
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Miriam Scadeng
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Brett R. Cowan
- Institute of Environmental Science and Research, Auckland, New Zealand
| | | | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King’s College London, London, UK
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16
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Gottwald LM, Blanken CPS, Tourais J, Smink J, Planken RN, Boekholdt SM, Meijboom LJ, Coolen BF, Strijkers GJ, Nederveen AJ, van Ooij P. Retrospective Camera-Based Respiratory Gating in Clinical Whole-Heart 4D Flow MRI. J Magn Reson Imaging 2021; 54:440-451. [PMID: 33694310 PMCID: PMC8359364 DOI: 10.1002/jmri.27564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Respiratory gating is generally recommended in 4D flow MRI of the heart to avoid blurring and motion artifacts. Recently, a novel automated contact‐less camera‐based respiratory motion sensor has been introduced. Purpose To compare camera‐based respiratory gating (CAM) with liver‐lung‐navigator‐based gating (NAV) and no gating (NO) for whole‐heart 4D flow MRI. Study Type Retrospective. Subjects Thirty two patients with a spectrum of cardiovascular diseases. Field Strength/Sequence A 3T, 3D‐cine spoiled‐gradient‐echo‐T1‐weighted‐sequence with flow‐encoding in three spatial directions. Assessment Respiratory phases were derived and compared against each other by cross‐correlation. Three radiologists/cardiologist scored images reconstructed with camera‐based, navigator‐based, and no respiratory gating with a 4‐point Likert scale (qualitative analysis). Quantitative image quality analysis, in form of signal‐to‐noise ratio (SNR) and liver‐lung‐edge (LLE) for sharpness and quantitative flow analysis of the valves were performed semi‐automatically. Statistical Tests One‐way repeated measured analysis of variance (ANOVA) with Wilks's lambda testing and follow‐up pairwise comparisons. Significance level of P ≤ 0.05. Krippendorff's‐alpha‐test for inter‐rater reliability. Results The respiratory signal analysis revealed that CAM and NAV phases were highly correlated (C = 0.93 ± 0.09, P < 0.01). Image scoring showed poor inter‐rater reliability and no significant differences were observed (P ≥ 0.16). The image quality comparison showed that NAV and CAM were superior to NO with higher SNR (P = 0.02) and smaller LLE (P < 0.01). The quantitative flow analysis showed significant differences between the three respiratory‐gated reconstructions in the tricuspid and pulmonary valves (P ≤ 0.05), but not in the mitral and aortic valves (P > 0.05). Pairwise comparisons showed that reconstructions without respiratory gating were different in flow measurements to either CAM or NAV or both, but no differences were found between CAM and NAV reconstructions. Data Conclusion Camera‐based respiratory gating performed as well as conventional liver‐lung‐navigator‐based respiratory gating. Quantitative image quality analysis showed that both techniques were equivalent and superior to no‐gating‐reconstructions. Quantitative flow analysis revealed local flow differences (tricuspid/pulmonary valves) in images of no‐gating‐reconstructions, but no differences were found between images reconstructed with camera‐based and navigator‐based respiratory gating. Level of Evidence 3 Technical Efficacy Stage 2
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Affiliation(s)
- Lukas M Gottwald
- Radiology and Nuclear Medicine, Amsterdam, Amsterdam University Medical Centers, location AMC, The Netherlands
| | - Carmen P S Blanken
- Radiology and Nuclear Medicine, Amsterdam, Amsterdam University Medical Centers, location AMC, The Netherlands
| | - João Tourais
- MR R&D-Clinical Science, Philips Healthcare, Best, The Netherlands.,Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Magnetic Resonance Systems Lab, Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Jouke Smink
- MR R&D-Clinical Science, Philips Healthcare, Best, The Netherlands
| | - R Nils Planken
- Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Lilian J Meijboom
- Radiology and Nuclear Medicine, Amsterdam, Amsterdam University Medical Centers, location AMC, The Netherlands
| | - Bram F Coolen
- Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Radiology and Nuclear Medicine, Amsterdam, Amsterdam University Medical Centers, location AMC, The Netherlands
| | - Pim van Ooij
- Radiology and Nuclear Medicine, Amsterdam, Amsterdam University Medical Centers, location AMC, The Netherlands
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17
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Kroeger JR, Pavesio FC, Mörsdorf R, Weiss K, Bunck AC, Baeßler B, Maintz D, Giese D. Velocity quantification in 44 healthy volunteers using accelerated multi-VENC 4D flow CMR. Eur J Radiol 2021; 137:109570. [PMID: 33596498 DOI: 10.1016/j.ejrad.2021.109570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the feasibility of a k-t accelerated multi-VENC 4D phase contrast flow MRI acquisition of the main heart-surrounding vessels, its benefits over a traditional single-VENC acquisition and to present reference flow and velocity values in a large cohort of volunteers. METHODS 44 healthy volunteers were examined on a 3 T MRI scanner (Ingenia, Philips, Best, The Netherlands). 4D flow measurements were obtained with a FOV including the aorta and the pulmonary arteries. VENC values were set to 40, 100 and 200 cm/s and unfolded based on an MRI signal model. Unfolded multi-VENC data was compared to the single-VENC with VENC 200 cm/s. Flow and velocity quantification was performed in several regions of interest (ROI) placed in the ascending aorta and in the main pulmonary artery. Conservation of mass analysis was performed for single- and multi-VENC datasets. Values for mean and maximal flow velocity and stroke volume were calculated and compared to the literature. RESULTS Mean scan time was 13.8 ± 4 min. Differences between stroke volumes between the ascending aorta and the main pulmonary artery were significantly lower in multi-VENC datasets compared to single-VENC datasets (9.6 ± 7.8 mL vs. 25.4 ± 26.4 mL, p < 0.001). This was also true for differences in stroke volume between up- and downstream ROIs in the ascending aorta and pulmonary artery. Values for mean and maximal velocities and stroke volume were in-line with previous studies. To highlight potential clinical applications two exemplary 4D flow measurements in patients with different pathologies are shown and compared to single-VENC datasets. CONCLUSIONS k-t accelerated multi-VENC 4D phase contrast flow MRI acquisition of the great vessels is feasible in a clinically acceptable scan duration. It offers improvements over traditional single-VENC 4D flow, expectedly being valuable when vessels with different flow velocities or complex flow phenomena are evaluated.
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Affiliation(s)
- Jan Robert Kroeger
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany.
| | - Francesca Claudia Pavesio
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Richard Mörsdorf
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Kilian Weiss
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Philips GmbH, Hamburg, Germany.
| | - Alexander Christian Bunck
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Bettina Baeßler
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - David Maintz
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Daniel Giese
- Department of Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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18
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Pathrose A, Ma L, Berhane H, Scott MB, Chow K, Forman C, Jin N, Serhal A, Avery R, Carr J, Markl M. Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease. Magn Reson Med 2020; 85:2174-2187. [PMID: 33107141 DOI: 10.1002/mrm.28561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To systematically assess the feasibility and performance of a highly accelerated compressed sensing (CS) 4D flow MRI framework at three different acceleration factors (R) for the quantification of aortic flow dynamics and wall shear stress (WSS) in patients with aortic disease. METHODS Twenty patients with aortic disease (58 ± 15 y old; 19 M) underwent four 4D flow scans: one conventional (GRAPPA, R = 2) and three CS 4D flows with R = 5.7, 7.7, and 10.2. All scans were acquired with otherwise equivalent imaging parameters on a 1.5T scanner. Peak-systolic velocity (Vmax ), peak flow (Qmax ), and net flow (Qnet ) were quantified at the ascending aorta (AAo), arch, and descending aorta (DAo). WSS was calculated at six regions within the AAo and arch. RESULTS Mean scan times for the conventional and CS 4D flows with R = 5.7, 7.7, and 10.2 were 9:58 ± 2:58 min, 3:40 ± 1:19 min, 2:50 ± 0:56 min, and 2:05 ± 0:42 min, respectively. Vmax , Qmax , and Qnet were significantly underestimated by all CS protocols (underestimation ≤ -7%, -9%, and -10% by CS, R = 5.7, 7.7, and 10.2, respectively). WSS measurements showed the highest underestimation by all CS protocols (underestimation ≤ -9%, -12%, and -14% by CS, R = 5.7, 7.7, and 10.2). CONCLUSIONS Highly accelerated aortic CS 4D flow at R = 5.7, 7.7, and 10.2 showed moderate agreement with the conventional 4D flow, despite systematically underestimating various hemodynamic parameters. The shortened scan time may enable the clinical translation of CS 4D flow, although potential hemodynamic underestimation should be considered when interpreting the results.
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Affiliation(s)
- Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Liliana Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Haben Berhane
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Kelvin Chow
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | | | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Ali Serhal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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19
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Validation of non-contrast multiple overlapping thin-slab 4D-flow cardiac magnetic resonance imaging. Magn Reson Imaging 2020; 74:223-231. [PMID: 33035638 DOI: 10.1016/j.mri.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/31/2020] [Accepted: 10/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) flow quantification is typically performed using 2D phase-contrast (PC) imaging of a plane perpendicular to flow. 3D-PC imaging (4D-flow) allows offline quantification anywhere in a thick slab, but is often limited by suboptimal signal, potentially alleviated by contrast enhancement. We developed a non-contrast 4D-flow sequence, which acquires multiple overlapping thin slabs (MOTS) to minimize signal loss, and hypothesized that it could improve image quality, diagnostic accuracy, and aortic flow measurements compared to non-contrast single-slab approach. METHODS We prospectively studied 20 patients referred for transesophageal echocardiography (TEE), who underwent CMR (GE, 3 T). 2D-PC images of the aortic valve and three 4D-flow datasets covering the heart were acquired, including single-slab, pre- and post-contrast, and non-contrast MOTS. Each 4D-flow dataset was interpreted blindly for ≥moderate valve disease and compared to TEE. Flow visualization through each valve was scored (0 to 4), and aortic-valve flow measured on each 4D-flow dataset and compared to 2D-PC reference. RESULTS Diagnostic quality visualization was achieved with the pre- and post-contrast 4D-flow acquisitions in 25% and 100% valves, respectively (scores 0.9 ± 1.1 and 3.8 ± 0.5), and in 58% with the non-contrast MOTS (1.6 ± 1.1). Accuracy of detection of valve disease was 75%, 92% and 82%, respectively. Aortic flow measurements were possible in 53%, 95% and in 89% patients, respectively. The correlation between pre-contrast single-slab measurements and 2D-PC reference was weak (r = 0.21), but improved with both contrast enhancement (r = 0.71) and with MOTS (r = 0.67). CONCLUSIONS Although non-contrast MOTS 4D-flow improves valve function visualization and diagnostic accuracy, a significant proportion of valves cannot be accurately assessed. However, aortic flow measurements using non-contrast MOTS is feasible and reaches similar accuracy to that of contrast-enhanced 4D-flow.
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20
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Catapano F, Pambianchi G, Cundari G, Rebelo J, Cilia F, Carbone I, Catalano C, Francone M, Galea N. 4D flow imaging of the thoracic aorta: is there an added clinical value? Cardiovasc Diagn Ther 2020; 10:1068-1089. [PMID: 32968661 DOI: 10.21037/cdt-20-452] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Four-dimensional (4D) flow MRI has emerged as a powerful non-invasive technique in cardiovascular imaging, enabling to analyse in vivo complex flow dynamics models by quantifying flow parameters and derived features. Deep knowledge of aortic flow dynamics is fundamental to better understand how abnormal flow patterns may promote or worsen vascular diseases. In the perspective of an increasingly personalized and preventive medicine, growing interest is focused on identifying those quantitative functional features which are early predictive markers of pathological evolution. The thoracic aorta and its spectrum of diseases, as the first area of application and development of 4D flow MRI and supported by an extensive experimental validation, represents the ideal model to introduce this technique into daily clinical practice. The purpose of this review is to describe the impact of 4D flow MRI in the assessment of the thoracic aorta and its most common affecting diseases, providing an overview of the actual clinical applications and describing the potential role of derived advanced hemodynamic measures in tailoring follow-up and treatment.
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Affiliation(s)
- Federica Catapano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.,Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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21
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Salavitabar A, Figueroa CA, Lu JC, Owens ST, Axelrod DM, Zampi JD. Emerging 3D technologies and applications within congenital heart disease: teach, predict, plan and guide. Future Cardiol 2020; 16:695-709. [PMID: 32628520 DOI: 10.2217/fca-2020-0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
3D visualization technologies have evolved to become a mainstay in the management of congenital heart disease (CHD) with a growing presence within multiple facets. Printed and virtual 3D models allow for a more comprehensive approach to educating trainees and care team members. Computational fluid dynamics can take 3D modeling to the next level, by predicting post-procedural outcomes and helping to determine surgical approach. 3D printing and extended reality are developing resources for pre-procedural planning and intra-procedural guidance with the potential to revolutionize decision-making and procedural success. Challenges still remain within existing technologies and their applications to the CHD field. Addressing these gaps, both by those within and outside of CHD, will transform education and patient care within our field.
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Affiliation(s)
- Arash Salavitabar
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
| | - C Alberto Figueroa
- Departments of Biomedical Engineering & Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jimmy C Lu
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
| | - Sonal T Owens
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
| | - David M Axelrod
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Jeffrey D Zampi
- C.S. Mott Children's Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA
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22
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Abstract
Magnetic resonance imaging (MRI) has become an important tool for the clinical evaluation of patients with cardiac and vascular diseases. Since its introduction in the late 1980s, quantitative flow imaging with MRI has become a routine part of standard-of-care cardiothoracic and vascular MRI for the assessment of pathological changes in blood flow in patients with cardiovascular disease. More recently, time-resolved flow imaging with velocity encoding along all three flow directions and three-dimensional (3D) anatomic coverage (4D flow MRI) has been developed and applied to enable comprehensive 3D visualization and quantification of hemodynamics throughout the human circulatory system. This article provides an overview of the use of 4D flow applications in different cardiac and vascular regions in the human circulatory system, with a focus on using 4D flow MRI in cardiothoracic and cerebrovascular diseases.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois 60208, USA
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23
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Urmeneta Ulloa J, Álvarez Vázquez A, Martínez de Vega V, Cabrera JÁ. Evaluation of Cardiac Shunts With
4D
Flow Cardiac Magnetic Resonance: Intra‐ and Interobserver Variability. J Magn Reson Imaging 2020; 52:1055-1063. [DOI: 10.1002/jmri.27158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Javier Urmeneta Ulloa
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Ana Álvarez Vázquez
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - Vicente Martínez de Vega
- Radiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
| | - José Ángel Cabrera
- Cardiology Department. Quirón‐Salud University Hospital European University of Madrid Madrid Spain
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24
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Alvarez A, Martinez V, Pizarro G, Recio M, Cabrera JÁ. Clinical use of 4D flow MRI for quantification of aortic regurgitation. Open Heart 2020; 7:e001158. [PMID: 32153789 PMCID: PMC7046971 DOI: 10.1136/openhrt-2019-001158] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/27/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022] Open
Abstract
Objective The main objective of the present study was to compare the use of four-dimensional (4D) flow MRI with the habitual sequence (two-dimensional phase-contrast (2DPC) MRI) for the assessment of aortic regurgitation (AR) in the clinical routine. Methods This was a retrospective, observational cohort study of patients with varying grades of AR. For the purposes of the present study, we selected all the cases with a regurgitant fraction (RF)>5% as determined by 2DPC MRI (n=34). In all cases, both sequences (2DPC and 4D flow MRI) were acquired in a single session to ensure comparability. We compared the results of the two techniques by evaluating forward flow, regurgitant flow and regurgitation fraction. Then, the patients were divided into subgroups to determine if these factors had any influence on the measurements: aortic diameter (≤ vs >38 mm), valve anatomy (tricuspid vs bicuspid/quadricuspid), stenosis (gradient ≥15 vs <15) and region of interest location (aortic valve vs sinotubular junction). Results No statistically significant differences were observed between the two techniques with Pearson’s correlation coefficients (r) of forward flow (r=0.826/p value<0001), regurgitant flow (r=0.866/p value<0001) and RF (r=0.761/p value<0001). Conclusions The findings of this study confirm the value of 4D flow MRI for grading AR in clinical practice with an excellent correlation with the standard technique (2DPC MRI).
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Affiliation(s)
- Ana Alvarez
- Imaging Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | - Vicente Martinez
- Imaging Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Gonzalo Pizarro
- Universidad Europea de Madrid, Madrid, Spain.,Department of Cardiology, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
| | - Manuel Recio
- Imaging Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Jose Ángel Cabrera
- Department of Cardiology, Hospital Universitario Quironsalud Madrid, Madrid, Madrid, Spain
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25
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Belhadjer Z, Soulat G, Ladouceur M, Pitocco F, Legendre A, Bonnet D, Iserin L, Mousseaux E. Neopulmonary Outflow Tract Obstruction Assessment by 4D Flow MRI in Adults With Transposition of the Great Arteries After Arterial Switch Operation. J Magn Reson Imaging 2019; 51:1699-1705. [PMID: 31794141 DOI: 10.1002/jmri.27012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The main complication in adult patients with transposition of the great arteries (TGA) treated by an arterial switch operation (ASO) is neopulmonary outflow tract stenosis (NPOTS). However, pulmonary flow velocity measurements cannot always be performed with transthoracic echocardiography (TTE) due to complex anatomical features. 4D flow MRI allows detection, quantification, and location of the obstruction site along the NPOTS. PURPOSE AND HYPOTHESIS To investigate the accuracy of 4D flow for the diagnosis of NPOTS in adults with TGA corrected by ASO. STUDY TYPE Prospective. POPULATION Thirty-three adult patients with TGA treated by ASO (19 men, mean age 25.5 years old). FIELD STRENGTH/SEQUENCE Accelerated 4D flow research sequence at 3T. ASSESSMENT Maximum NPOTS velocities on TTE and 4D flow MRI done the same day. STATISTICAL TESTS Pearson correlation coefficient, paired t-test, and Bland-Altman analysis were used to investigate the relationship between TTE and MRI data. RESULTS In 16 patients (48.5%), evaluation of NPOTS anatomy was not obtained by TTE, while it was always possible by 4D flow. Peak flow velocity (PV) measurements in Doppler and 4D flow were highly correlated (r = 0.78; P < 0.001). PV >350 cm.s-1 was detected in only one patient (3%) by TTE vs. five patients (15%) by 4D flow. Moreover, a high correlation was found between PV and the right ventricle (RV) mass index to body surface area when using 4D flow (r = 0.63; P < 0.001). The location of NPOTS was determined in all patients using 4D flow and concerned the main pulmonary artery in 42%. DATA CONCLUSION Compared to TTE, 4D flow MRI provides better sensitivity to detect and locate NPOTS in patients with TGA treated by ASO. 4D flow PV measurements in NPOTS were well correlated with TTE PV and RV mass. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1699-1705.
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Affiliation(s)
- Zahra Belhadjer
- PARCC, INSERM 970, F-75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France
| | - Gilles Soulat
- PARCC, INSERM 970, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Magalie Ladouceur
- PARCC, INSERM 970, F-75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | | | - Antoine Legendre
- Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France
| | - Damien Bonnet
- Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Laurence Iserin
- Assistance Publique Hôpitaux de Paris, Hôpital Necker enfant malades, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France
| | - Elie Mousseaux
- PARCC, INSERM 970, F-75015, Paris, France.,Université de Paris, F-75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
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26
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Rotman YZ, Alshawabkeh L, Horowitz M, Hsiao A. 4D Flow Cardiac Magnetic Resonance Uncovers the Cause of Bioprosthetic Pulmonary Valve Dysfunction. JACC Case Rep 2019; 1:485-486. [PMID: 34316861 PMCID: PMC8289148 DOI: 10.1016/j.jaccas.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 06/13/2023]
Abstract
We present a case of a 20-year-old man with tetralogy of Fallot status post-repair with a transannular patch and left pulmonary artery reconstruction at age 1 and subsequent pulmonary valve replacement with bioprosthetic valve 3 years ago. A transthoracic echocardiogram revealed severe bioprosthetic valve insufficiency. Cardiac magnetic resonance with 4-dimensional flow revealed a paravalvular leak. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | | | | | - Albert Hsiao
- University of California-San Diego, La Jolla, California
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27
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Leiner T, Rueckert D, Suinesiaputra A, Baeßler B, Nezafat R, Išgum I, Young AA. Machine learning in cardiovascular magnetic resonance: basic concepts and applications. J Cardiovasc Magn Reson 2019; 21:61. [PMID: 31590664 PMCID: PMC6778980 DOI: 10.1186/s12968-019-0575-y] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 09/02/2019] [Indexed: 12/18/2022] Open
Abstract
Machine learning (ML) is making a dramatic impact on cardiovascular magnetic resonance (CMR) in many ways. This review seeks to highlight the major areas in CMR where ML, and deep learning in particular, can assist clinicians and engineers in improving imaging efficiency, quality, image analysis and interpretation, as well as patient evaluation. We discuss recent developments in the field of ML relevant to CMR in the areas of image acquisition & reconstruction, image analysis, diagnostic evaluation and derivation of prognostic information. To date, the main impact of ML in CMR has been to significantly reduce the time required for image segmentation and analysis. Accurate and reproducible fully automated quantification of left and right ventricular mass and volume is now available in commercial products. Active research areas include reduction of image acquisition and reconstruction time, improving spatial and temporal resolution, and analysis of perfusion and myocardial mapping. Although large cohort studies are providing valuable data sets for ML training, care must be taken in extending applications to specific patient groups. Since ML algorithms can fail in unpredictable ways, it is important to mitigate this by open source publication of computational processes and datasets. Furthermore, controlled trials are needed to evaluate methods across multiple centers and patient groups.
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Affiliation(s)
- Tim Leiner
- Department of Radiology | E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College, London, UK
| | - Avan Suinesiaputra
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA USA
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King’s College London, London, UK
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28
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Ma LE, Markl M, Chow K, Vali A, Wu C, Schnell S. Efficient triple-VENC phase-contrast MRI for improved velocity dynamic range. Magn Reson Med 2019; 83:505-520. [PMID: 31423646 DOI: 10.1002/mrm.27943] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the utility of an efficient triple velocity-encoding (VENC) 4D flow MRI implementation to improve velocity unwrapping of 4D flow MRI data with the same scan time as an interleaved dual-VENC acquisition. METHODS A balanced 7-point acquisition was used to derive 3 sets of 4D flow images corresponding to 3 different VENCs. These 3 datasets were then used to unwrap the aliased lowest VENC into a minimally aliased, triple-VENC dataset. Triple-VENC MRI was evaluated and compared with dual-VENC MRI over 3 different VENC ranges (50-150, 60-150, and 60-180 cm/s) in vitro in a steadily rotating phantom as well as in a pulsatile flow phantom. In vivo, triple-VENC data of the thoracic aorta were also evaluated in 3 healthy volunteers (2 males, 26-44 years old) with VENC = 50/75/150 cm/s. Two triple-VENC (triconditional and biconditional) and 1 dual-VENC unwrapping algorithms were quantitatively assessed through comparison to a reference, unaliased, single-VENC scan. RESULTS Triple-VENC 4D flow constant rotation phantom results showed high correlation with the analytical solution (intraclass correlation coefficient = 0.984-0.995, P < .001) and up to a 61% reduction in velocity noise compared with the corresponding single-VENC scans (VENC = 150, 180 cm/s). Pulsatile flow phantom experiments demonstrated good agreement between triple-VENC and single-VENC acquisitions (peak flow < 0.8% difference; peak velocity < 11.7% difference). Triconditional triple-VENC unwrapping consistently outperformed dual-VENC unwrapping, correctly unwrapping more than 83% and 46%-66% more voxels in vitro and in vivo, respectively. CONCLUSION Triple-VENC 4D flow MRI adds no additional scan time to dual-VENC MRI and has the potential for improved unwrapping to extend the velocity dynamic range beyond dual-VENC methods.
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Affiliation(s)
- Liliana E Ma
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Kelvin Chow
- Department of Radiology, Northwestern University, Chicago, Illinois.,Cardiovascular MR R&D, Siemens Medical Solutions USA, Chicago, Illinois
| | - Alireza Vali
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Can Wu
- Philips Healthcare, Andover, Massachusetts
| | - Susanne Schnell
- Department of Radiology, Northwestern University, Chicago, Illinois
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29
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Zhong L, Schrauben EM, Garcia J, Uribe S, Grieve SM, Elbaz MSM, Barker AJ, Geiger J, Nordmeyer S, Marsden A, Carlsson M, Tan RS, Garg P, Westenberg JJM, Markl M, Ebbers T. Intracardiac 4D Flow MRI in Congenital Heart Disease: Recommendations on Behalf of the ISMRM Flow & Motion Study Group. J Magn Reson Imaging 2019; 50:677-681. [PMID: 31317587 DOI: 10.1002/jmri.26858] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/08/2022] Open
Abstract
LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:677-681.
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Affiliation(s)
- Liang Zhong
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | - Eric M Schrauben
- Translational Medicine, Hospital for Sick Children, Toronto, Canada
| | - Julio Garcia
- Departments of Radiology and Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Sergio Uribe
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Radiology Department and Biomedical Imaging Center, School of Medicine, Pontifica Universidad Catolica de Chile, Chile
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia; Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Mohammed S M Elbaz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology and Bioengineering, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland
| | - Sarah Nordmeyer
- Department of Pediatric Cardiology and Congenital Heart Diseases German Heart Center Berlin Germany; Institute for Cardiovascular Computer-assisted Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - Alison Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California, USA
| | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School Singapore, National University of Singapore, Singapore
| | | | | | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tino Ebbers
- Department of Medical and Health Sciences and Center for Medical Imaging Sciences and Visualization, Linköping University, Sweden
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30
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Mönch S, Sollmann N, Hock A, Zimmer C, Kirschke JS, Hedderich DM. Magnetic Resonance Imaging of the Brain Using Compressed Sensing - Quality Assessment in Daily Clinical Routine. Clin Neuroradiol 2019; 30:279-286. [PMID: 31098666 DOI: 10.1007/s00062-019-00789-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the effect of compressed sensing (CS) on image quality and acquisition speed in routine brain magnetic resonance imaging (MRI). METHODS During a 2-month implementation period of CS, two senior neuroradiologists, one MRI physicist and one application specialist optimized the CS acceleration factor to reduce scan time and improve spatial resolution, while maintaining image quality. Afterwards, two neuroradiologists independently scored image quality on a 5-point Likert scale in 3‑dimensional (3D) fluid attenuation inversion recovery (FLAIR), 3D double inversion recovery (DIR), 3D T2, 3D T1, 3D T1 + gadoteric acid, axial T2, axial FLAIR, axial T2*, and 3D arterial time-of-flight MR angiography (art. TOF) sequences acquired during 1 week before (CS-) and after (CS+) the implementation of CS. Time of acquisition was recorded for all sequences. RESULTS A total of 51 CS- and 48 CS+ patients were included. The median scan time reduction was 29.3% (range 0.0-58.4%), median voxel size reduction was 10.5% (0.0-33.3%). The CS+ image quality was rated superior for 3D FLAIR (p < 0.001), 3D T2 (p = 0.001), and axial T2* sequences (p = 0.024). For all other sequences, no statistical difference in image quality was observed. Interreader agreement regarding image quality was good for all sequences (weighted Cohen's κ > 0.5). CONCLUSION The use of CS saves considerable imaging time while allowing to increase spatial resolution in routine clinical brain MRI without loss in image quality.
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Affiliation(s)
- Sebastian Mönch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | | | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Dennis M Hedderich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
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31
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Krieger EV, Stout KK, Grosse-Wortmann L. How to Image Congenital Left Heart Obstruction in Adults. Circ Cardiovasc Imaging 2019; 10:CIRCIMAGING.116.004271. [PMID: 28495822 DOI: 10.1161/circimaging.116.004271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Eric V Krieger
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.)
| | - Karen K Stout
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.)
| | - Lars Grosse-Wortmann
- From the Seattle Adult Congenital Heart Service, University of Washington Medical Center (E.V.K., K.K.S.); Seattle Children's Hospital, Washington (E.V.K., K.K.S.); Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle (E.V.K., K.K.S.); and Labatt Family Heart Centre, Department of Pediatrics, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, ON, Canada (L.G.-W.).
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32
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Ma LE, Markl M, Chow K, Huh H, Forman C, Vali A, Greiser A, Carr J, Schnell S, Barker AJ, Jin N. Aortic 4D flow MRI in 2 minutes using compressed sensing, respiratory controlled adaptive k-space reordering, and inline reconstruction. Magn Reson Med 2019; 81:3675-3690. [PMID: 30803006 DOI: 10.1002/mrm.27684] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the accuracy and feasibility of a free-breathing 4D flow technique using compressed sensing (CS), where 4D flow imaging of the thoracic aorta is performed in 2 min with inline image reconstruction on the MRI scanner in less than 5 min. METHODS The 10 in vitro 4D flow MRI scans were performed with different acceleration rates on a pulsatile flow phantom (9 CS acceleration factors [R = 5.4-14.1], 1 generalized autocalibrating partially parallel acquisition [GRAPPA] R = 2). Based on in vitro results, CS-accelerated 4D flow of the thoracic aorta was acquired in 20 healthy volunteers (38.3 ± 15.2 years old) and 11 patients with aortic disease (61.3 ± 15.1 years) with R = 7.7. A conventional 4D flow scan was acquired with matched spatial coverage and temporal resolution. RESULTS CS depicted similar hemodynamics to conventional 4D flow in vitro, and in vivo, with >70% reduction in scan time (volunteers: 1:52 ± 0:25 versus 7:25 ± 2:35 min). Net flow values were within 3.5% in healthy volunteers, and voxel-by-voxel comparison demonstrated good agreement. CS significantly underestimated peak velocities (vmax ) and peak flow (Qmax ) in both volunteers and patients (volunteers: vmax , -16.2% to -9.4%, Qmax : -11.6% to -2.9%, patients: vmax , -11.2% to -4.0%; Qmax , -10.2% to -5.8%). CONCLUSION Aortic 4D flow with CS is feasible in a two minute scan with less than 5 min for inline reconstruction. While net flow agreement was excellent, CS with R = 7.7 produced underestimation of Qmax and vmax ; however, these were generally within 13% of conventional 4D flow-derived values. This approach allows 4D flow to be feasible in clinical practice for comprehensive assessment of hemodynamics.
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Affiliation(s)
- Liliana E Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Kelvin Chow
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc, Chicago, Illinois
| | - Hyungkyu Huh
- Daegu-Gyeongbuk Medical Innovation Foundation, Medical Device Development Center, Daegu, South Korea
| | | | - Alireza Vali
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Denver, Colorado.,Department of Bioengineering, University of Colorado, Anschutz Medical Campus, Denver, Colorado
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc, Cleveland, Ohio
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Feneis JF, Kyubwa E, Atianzar K, Cheng JY, Alley MT, Vasanawala SS, Demaria AN, Hsiao A. 4D flow MRI quantification of mitral and tricuspid regurgitation: Reproducibility and consistency relative to conventional MRI. J Magn Reson Imaging 2018; 48:1147-1158. [PMID: 29638024 PMCID: PMC7962150 DOI: 10.1002/jmri.26040] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/20/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In patients with mitral or tricuspid valve regurgitation, evaluation of regurgitant severity is essential for determining the need for surgery. While transthoracic echocardiography is widely accessible, it has limited reproducibility for grading inlet valve regurgitation. Multiplanar cardiac MRI is the quantitative standard but requires specialized local expertise, and is thus not widely available. Volumetric 4D flow MRI has potential for quantitatively grading the severity of inlet valve regurgitation in adult patients. PURPOSE To evaluate the accuracy and reproducibility of volumetric 4D flow MRI for quantification of inlet valvular regurgitation compared to conventional multiplanar MRI, which may simplify and improve accessibility of cardiac MRI. STUDY TYPE This retrospective, HIPAA-compliant imaging-based comparison study was conducted at a single institution. SUBJECTS Twenty-one patients who underwent concurrent multiplanar and 4D flow cardiac MRI between April 2015 and January 2017. FIELD STRENGTH/SEQUENCES 3T; steady-state free-precession (SSFP), 2D phase contrast (2D-PC), and postcontrast 4D flow. ASSESSMENT We evaluated the intertechnique (4D flow vs. 2D-PC), intermethod (direct vs. indirect measurement), interobserver and intraobserver reproducibility of measurements of regurgitant flow volume (RFV), fraction (RF), and volume (RVol). STATISTICAL TESTS Statistical analysis included Pearson correlation, Bland-Altman statistics, and intraclass correlation coefficients. RESULTS There was high concordance between 4D flow and multiplanar MRI, whether using direct or indirect methods of quantifying regurgitation (r = 0.813-0.985). Direct interrogation of the regurgitant jet with 4D flow showed high intraobserver consistency (r = 0.976-0.999) and interobserver consistency (r = 0.861-0.992), and correlated well with traditional indirect measurements obtained as the difference between stroke volume and forward outlet valve flow. DATA CONCLUSION 4D flow MRI provides highly reproducible measurements of mitral and tricuspid regurgitant volume, and may be used in place of conventional multiplanar MRI. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1147-1158.
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Affiliation(s)
| | - Espoir Kyubwa
- Department of Radiology, UC San Diego, La Jolla, California, USA
| | - Kimberly Atianzar
- Department of Cardiovascular Disease, Swedish Heart and Vascular Institute, Seattle, WA
| | | | | | | | | | - Albert Hsiao
- Department of Radiology, UC San Diego, La Jolla, California, USA
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34
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Liu J, Koskas L, Faraji F, Kao E, Wang Y, Haraldsson H, Kefayati S, Zhu C, Ahn S, Laub G, Saloner D. Highly accelerated intracranial 4D flow MRI: evaluation of healthy volunteers and patients with intracranial aneurysms. MAGMA (NEW YORK, N.Y.) 2018; 31:295-307. [PMID: 28785850 PMCID: PMC5803461 DOI: 10.1007/s10334-017-0646-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate an accelerated 4D flow MRI method that provides high temporal resolution in a clinically feasible acquisition time for intracranial velocity imaging. MATERIALS AND METHODS Accelerated 4D flow MRI was developed by using a pseudo-random variable-density Cartesian undersampling strategy (CIRCUS) with the combination of k-t, parallel imaging and compressed sensing image reconstruction techniques (k-t SPARSE-SENSE). Four-dimensional flow data were acquired on five healthy volunteers and eight patients with intracranial aneurysms using CIRCUS (acceleration factor of R = 4, termed CIRCUS4) and GRAPPA (R = 2, termed GRAPPA2) as the reference method. Images with three times higher temporal resolution (R = 12, CIRCUS12) were also reconstructed from the same acquisition as CIRCUS4. Qualitative and quantitative image assessment was performed on the images acquired with different methods, and complex flow patterns in the aneurysms were identified and compared. RESULTS Four-dimensional flow MRI with CIRCUS was achieved in 5 min and allowed further improved temporal resolution of <30 ms. Volunteer studies showed similar qualitative and quantitative evaluation obtained with the proposed approach compared to the reference (overall image scores: GRAPPA2 3.2 ± 0.6; CIRCUS4 3.1 ± 0.7; CIRCUS12 3.3 ± 0.4; difference of the peak velocities: -3.83 ± 7.72 cm/s between CIRCUS4 and GRAPPA2, -1.72 ± 8.41 cm/s between CIRCUS12 and GRAPPA2). In patients with intracranial aneurysms, the higher temporal resolution improved capturing of the flow features in intracranial aneurysms (pathline visualization scores: GRAPPA2 2.2 ± 0.2; CIRCUS4 2.5 ± 0.5; CIRCUS12 2.7 ± 0.6). CONCLUSION The proposed rapid 4D flow MRI with a high temporal resolution is a promising tool for evaluating intracranial aneurysms in a clinically feasible acquisition time.
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Affiliation(s)
- Jing Liu
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.
| | - Louise Koskas
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Farshid Faraji
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Evan Kao
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Yan Wang
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Henrik Haraldsson
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Sarah Kefayati
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Chengcheng Zhu
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | | | | | - David Saloner
- Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
- Radiology Service, VA Medical Center, San Francisco, CA, USA
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Masutani EM, Contijoch F, Kyubwa E, Cheng J, Alley MT, Vasanawala S, Hsiao A. Volumetric segmentation-free method for rapid visualization of vascular wall shear stress using 4D flow MRI. Magn Reson Med 2018. [PMID: 29516632 DOI: 10.1002/mrm.27159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To develop a rapid segmentation-free method to visualize and compute wall shear stress (WSS) throughout the aorta using 4D Flow MRI data. WSS is the drag force-per-area the vessel endothelium exerts on luminal blood; abnormal levels of WSS are associated with cardiovascular pathologies. Previous methods for computing WSS are bottlenecked by labor-intensive manual segmentation of vessel boundaries. A rapid automated segmentation-free method for computing WSS is presented. THEORY AND METHODS Shear stress is the dot-product of the viscous stress tensor and the inward normal vector. The inward normal vectors are approximated as the gradient of fluid speed at every voxel. Subsequently, a 4D map of shear stress is computed as the partial derivatives of velocity with respect to the inward normal vectors. We highlight the shear stress near the wall by fusing visualization with edge-emphasized anatomical data. RESULTS As a proof-of-concept, four cases with aortic pathologies are presented. Visualization allows for rapid localization of pathologic WSS. Subsequent analysis of these pathological regions enables quantification of WSS. Average WSS during peak systole measures approximately 50-60 cPa in nonpathological regions of the aorta and is elevated in regions of stenosis, coarctation, and dissection. WSS is reduced in regions of aneurysm. CONCLUSION A volumetric technique for calculation and visualization of WSS from 4D Flow MRI data is presented. Traditional labor-intensive methods for WSS rely on explicit manual segmentation of vessel boundaries before visualization. This automated volumetric strategy for visualization and quantification of WSS may facilitate its clinical translation.
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Affiliation(s)
- Evan M Masutani
- Medical Scientist Training Program, University of California, San Diego, La Jolla, California.,Department of Medicine, University of California, San Diego, La Jolla, California
| | - Francisco Contijoch
- Department of Bioengineering, University of California, San Diego, La Jolla, California.,Department of Radiology, University of California, San Diego, La Jolla, California
| | - Espoir Kyubwa
- Medical Scientist Training Program, University of California, San Diego, La Jolla, California.,Department of Medicine, University of California, San Diego, La Jolla, California
| | - Joseph Cheng
- Department of Radiology, Stanford University, Stanford, California
| | - Marcus T Alley
- Department of Radiology, Stanford University, Stanford, California
| | | | - Albert Hsiao
- Department of Radiology, University of California, San Diego, La Jolla, California
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Li CQ, Hsiao A, Hattangadi-Gluth J, Handwerker J, Farid N. Early Hemodynamic Response Assessment of Stereotactic Radiosurgery for a Cerebral Arteriovenous Malformation Using 4D Flow MRI. AJNR Am J Neuroradiol 2018; 39:678-681. [PMID: 29371257 DOI: 10.3174/ajnr.a5535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/13/2017] [Indexed: 11/07/2022]
Abstract
Brain AVMs treated with stereotactic radiosurgery typically demonstrate a minimum latency period of 1-3 years between treatment and nidus obliteration. Assessment of treatment response is usually limited to evaluation of AVM nidus structural changes using conventional MR imaging and MRA techniques. This report describes the use of 4D Flow MRI to also measure radiation-induced hemodynamic changes in a Spetzler-Martin grade III AVM, which were detectable as early as 6 months after treatment.
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Affiliation(s)
- C Q Li
- From the Department of Radiology (C.Q.L., A.H., J.H., N.F.), University of California, San Diego, San Diego, California
| | - A Hsiao
- From the Department of Radiology (C.Q.L., A.H., J.H., N.F.), University of California, San Diego, San Diego, California
| | - J Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences (J.H.-G.), University of California, San Diego, La Jolla, California
| | - J Handwerker
- From the Department of Radiology (C.Q.L., A.H., J.H., N.F.), University of California, San Diego, San Diego, California
| | - N Farid
- From the Department of Radiology (C.Q.L., A.H., J.H., N.F.), University of California, San Diego, San Diego, California
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Qureshi MY, O'Leary PW, Connolly HM. Cardiac imaging in Ebstein anomaly. Trends Cardiovasc Med 2018; 28:403-409. [PMID: 29409687 DOI: 10.1016/j.tcm.2018.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 11/29/2022]
Abstract
Ebstein anomaly is a congenital disorder of right ventricular myocardial development, which affects the tricuspid valve in addition to the right ventricular myocardium. Cardiac imaging by transthoracic echocardiography and cardiac magnetic resonance imaging are the key modalities used to assess timing and type of surgery. In this article, we review the current standards of echocardiographic and magnetic resonance imaging in Ebstein anomaly.
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Affiliation(s)
| | - Patrick W O'Leary
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Pelvic Blood Flow Predicts Fibroid Volume and Embolic Required for Uterine Fibroid Embolization: A Pilot Study With 4D Flow MR Angiography. AJR Am J Roentgenol 2017; 210:189-200. [PMID: 29090998 DOI: 10.2214/ajr.17.18127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We report here an initial experience using 4D flow MRI in pelvic imaging-specifically, in imaging uterine fibroids. We hypothesized that blood flow might correlate with fibroid volume and that quantifying blood flow might help to predict the amount of embolic required to achieve stasis at subsequent uterine fibroid embolization (UFE). MATERIALS AND METHODS Thirty-three patients with uterine fibroids and seven control subjects underwent pelvic MRI with 4D flow imaging. Of the patients with fibroids, 10 underwent 4D flow imaging before UFE and seven after UFE; in the remaining 16 patients with fibroids, UFE had yet to be performed. Four-dimensional flow measurements were performed using Arterys CV Flow. The flow fraction of the internal iliac artery was expressed as the ratio of internal iliac artery flow to external iliac artery flow and was compared between groups. The flow ratios between the internal iliac arteries on each side were calculated. Fibroid volume versus internal iliac flow fraction, embolic volume versus internal iliac flow fraction, and embolic volume ratio between sides versus the ratio of internal iliac artery flows between sides were compared. RESULTS The mean internal iliac flow fraction was significantly higher in the 26 patients who underwent imaging before UFE (mean ± standard error, 0.78 ± 0.06) than in the seven patients who underwent imaging after UFE (0.48 ± 0.07, p < 0.01) and in the seven control patients without fibroids (0.48 ± 0.08, p < 0.0001). The internal iliac flow fraction correlated well with fibroid volumes before UFE (r = 0.7754, p < 0.0001) and did not correlate with fibroid volumes after UFE (r = -0.3051, p = 0.51). The ratio of embolic required to achieve stasis between sides showed a modest correlation with the ratio of internal iliac flow (r = 0.6776, p = 0.03). CONCLUSION Internal iliac flow measured by 4D flow MRI correlates with fibroid volume and is predictive of the ratio of embolic required to achieve stasis on each side at subsequent UFE and may be useful for preprocedural evaluation of patients with uterine fibroids.
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Comprehensive Multi-Dimensional MRI for the Simultaneous Assessment of Cardiopulmonary Anatomy and Physiology. Sci Rep 2017; 7:5330. [PMID: 28706270 PMCID: PMC5509743 DOI: 10.1038/s41598-017-04676-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/18/2017] [Indexed: 01/22/2023] Open
Abstract
Diagnostic testing often assesses the cardiovascular or respiratory systems in isolation, ignoring the major pathophysiologic interactions between the systems in many diseases. When both systems are assessed currently, multiple modalities are utilized in costly fashion with burdensome logistics and decreased accessibility. Thus, we have developed a new acquisition and reconstruction paradigm using the flexibility of MRI to enable a comprehensive exam from a single 5-15 min scan. We constructed a compressive-sensing approach to pseudo-randomly acquire highly subsampled, multi-dimensionally-encoded and time-stamped data from which we reconstruct volumetric cardiac and respiratory motion phases, contrast-agent dynamics, and blood flow velocity fields. The proposed method, named XD flow, is demonstrated for (a) evaluating congenital heart disease, where the impact of bulk motion is reduced in a non-sedated neonatal patient and (b) where the observation of the impact of respiration on flow is necessary for diagnostics; (c) cardiopulmonary imaging, where cardiovascular flow, function, and anatomy information is needed along with pulmonary perfusion quantification; and in (d) renal function imaging, where blood velocities and glomerular filtration rates are simultaneously measured, which highlights the generality of the technique. XD flow has the ability to improve quantification and to provide additional data for patient diagnosis for comprehensive evaluations.
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40
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Basha TA, Akçakaya M, Liew C, Tsao CW, Delling FN, Addae G, Ngo L, Manning WJ, Nezafat R. Clinical performance of high-resolution late gadolinium enhancement imaging with compressed sensing. J Magn Reson Imaging 2017; 46:1829-1838. [PMID: 28301075 DOI: 10.1002/jmri.25695] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 02/15/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate diagnostic image quality of 3D late gadolinium enhancement (LGE) with high isotropic spatial resolution (∼1.4 mm3 ) images reconstructed from randomly undersampled k-space using LOw-dimensional-structure Self-learning and Thresholding (LOST). MATERIALS AND METHODS We prospectively enrolled 270 patients (181 men; 55 ± 14 years) referred for myocardial viability assessment. 3D LGE with isotropic spatial resolution of 1.4 ± 0.1 mm3 was acquired at 1.5T using a LOST acceleration rate of 3 to 5. In a subset of 121 patients, 3D LGE or phase-sensitive LGE were acquired with parallel imaging with an acceleration rate of 2 for comparison. Two readers evaluated image quality using a scale of 1 (poor) to 4 (excellent) and assessed for scar presence. The McNemar test statistic was used to compare the proportion of detected scar between the two sequences. We assessed the association between image quality and characteristics (age, gender, torso dimension, weight, heart rate), using generalized linear models. RESULTS Overall, LGE detection proportions for 3D LGE with LOST were similar between readers 1 and 2 (16.30% vs. 18.15%). For image quality, readers gave 85.9% and 80.0%, respectively, for images categorized as good or excellent. Overall proportion of scar presence was not statistically different from conventional 3D LGE (28% vs. 33% [P = 0.17] for reader 1 and 26% vs. 31% [P = 0.37] for reader 2). Increasing subject heart rate was associated with lower image quality (estimated slope = -0.009 (P = 0.001)). CONCLUSION High-resolution 3D LGE with LOST yields good to excellent image quality in >80% of patients and identifies patients with LV scar at the same rate as conventional 3D LGE. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1829-1838.
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Affiliation(s)
- Tamer A Basha
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Systems and Biomedical Engineering Department, University of Cairo, Cairo, Egypt
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota, USA.,Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Charlene Liew
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Connie W Tsao
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Francesca N Delling
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Gifty Addae
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Warren J Manning
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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41
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Bollache E, Barker AJ, Dolan RS, Carr JC, van Ooij P, Ahmadian R, Powell A, Collins JD, Geiger J, Markl M. k-t accelerated aortic 4D flow MRI in under two minutes: Feasibility and impact of resolution, k-space sampling patterns, and respiratory navigator gating on hemodynamic measurements. Magn Reson Med 2017; 79:195-207. [PMID: 28266062 DOI: 10.1002/mrm.26661] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the performance of highly accelerated free-breathing aortic four-dimensional (4D) flow MRI acquired in under 2 minutes compared to conventional respiratory gated 4D flow. METHODS Eight k-t accelerated nongated 4D flow MRI (parallel MRI with extended and averaged generalized autocalibrating partially parallel acquisition kernels [PEAK GRAPPA], R = 5, TRes = 67.2 ms) using four ky -kz Cartesian sampling patterns (linear, center-out, out-center-out, random) and two spatial resolutions (SRes1 = 3.5 × 2.3 × 2.6 mm3 , SRes2 = 4.5 × 2.3 × 2.6 mm3 ) were compared in vitro (aortic coarctation flow phantom) and in 10 healthy volunteers, to conventional 4D flow (16 mm-navigator acceptance window; R = 2; TRes = 39.2 ms; SRes = 3.2 × 2.3 × 2.4 mm3 ). The best k-t accelerated approach was further assessed in 10 patients with aortic disease. RESULTS The k-t accelerated in vitro aortic peak flow (Qmax), net flow (Qnet), and peak velocity (Vmax) were lower than conventional 4D flow indices by ≤4.7%, ≤ 11%, and ≤22%, respectively. In vivo k-t accelerated acquisitions were significantly shorter but showed a trend to lower image quality compared to conventional 4D flow. Hemodynamic indices for linear and out-center-out k-space samplings were in agreement with conventional 4D flow (Qmax ≤ 13%, Qnet ≤ 13%, Vmax ≤ 17%, P > 0.05). CONCLUSION Aortic 4D flow MRI in under 2 minutes is feasible with moderate underestimation of flow indices. Differences in k-space sampling patterns suggest an opportunity to mitigate image artifacts by an optimal trade-off between scan time, acceleration, and k-space sampling. Magn Reson Med 79:195-207, 2018. © 2018 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Emilie Bollache
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ryan Scott Dolan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pim van Ooij
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Rouzbeh Ahmadian
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex Powell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Julia Geiger
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
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Qualitative grading of aortic regurgitation: a pilot study comparing CMR 4D flow and echocardiography. Int J Cardiovasc Imaging 2016; 32:301-307. [PMID: 26498478 PMCID: PMC4737795 DOI: 10.1007/s10554-015-0779-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/25/2015] [Indexed: 11/21/2022]
Abstract
Over the past 10 years there has been intense research in the development of volumetric visualization of intracardiac flow by cardiac magnetic resonance (CMR). This volumetric time resolved technique called CMR 4D flow imaging has several advantages over standard CMR. It offers anatomical, functional and flow information in a single free-breathing, ten-minute acquisition. However, the data obtained is large and its processing requires dedicated software. We evaluated a cloud-based application package that combines volumetric data correction and visualization of CMR 4D flow data, and assessed its accuracy for the detection and grading of aortic valve regurgitation using transthoracic echocardiography as reference. Between June 2014 and January 2015, patients planned for clinical CMR were consecutively approached to undergo the supplementary CMR 4D flow acquisition. Fifty four patients (median age 39 years, 32 males) were included. Detection and grading of the aortic valve regurgitation using CMR 4D flow imaging were evaluated against transthoracic echocardiography. The agreement between 4D flow CMR and transthoracic echocardiography for grading of aortic valve regurgitation was good (κ = 0.73). To identify relevant, more than mild aortic valve regurgitation, CMR 4D flow imaging had a sensitivity of 100 % and specificity of 98 %. Aortic regurgitation can be well visualized, in a similar manner as transthoracic echocardiography, when using CMR 4D flow imaging.
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Yang ACY, Kretzler M, Sudarski S, Gulani V, Seiberlich N. Sparse Reconstruction Techniques in Magnetic Resonance Imaging: Methods, Applications, and Challenges to Clinical Adoption. Invest Radiol 2016; 51:349-64. [PMID: 27003227 PMCID: PMC4948115 DOI: 10.1097/rli.0000000000000274] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The family of sparse reconstruction techniques, including the recently introduced compressed sensing framework, has been extensively explored to reduce scan times in magnetic resonance imaging (MRI). While there are many different methods that fall under the general umbrella of sparse reconstructions, they all rely on the idea that a priori information about the sparsity of MR images can be used to reconstruct full images from undersampled data. This review describes the basic ideas behind sparse reconstruction techniques, how they could be applied to improve MRI, and the open challenges to their general adoption in a clinical setting. The fundamental principles underlying different classes of sparse reconstructions techniques are examined, and the requirements that each make on the undersampled data outlined. Applications that could potentially benefit from the accelerations that sparse reconstructions could provide are described, and clinical studies using sparse reconstructions reviewed. Lastly, technical and clinical challenges to widespread implementation of sparse reconstruction techniques, including optimization, reconstruction times, artifact appearance, and comparison with current gold standards, are discussed.
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Affiliation(s)
- Alice Chieh-Yu Yang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, USA
| | - Madison Kretzler
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, USA
| | - Sonja Sudarski
- Institute for Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Heidelberg, Germany
| | - Vikas Gulani
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, USA
- Department of Radiology, University Hospitals of Cleveland, Cleveland, USA
| | - Nicole Seiberlich
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, USA
- Department of Radiology, University Hospitals of Cleveland, Cleveland, USA
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44
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Advanced flow MRI: emerging techniques and applications. Clin Radiol 2016; 71:779-95. [PMID: 26944696 DOI: 10.1016/j.crad.2016.01.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) techniques provide non-invasive and non-ionising methods for the highly accurate anatomical depiction of the heart and vessels throughout the cardiac cycle. In addition, the intrinsic sensitivity of MRI to motion offers the unique ability to acquire spatially registered blood flow simultaneously with the morphological data, within a single measurement. In clinical routine, flow MRI is typically accomplished using methods that resolve two spatial dimensions in individual planes and encode the time-resolved velocity in one principal direction, typically oriented perpendicular to the two-dimensional (2D) section. This review describes recently developed advanced MRI flow techniques, which allow for more comprehensive evaluation of blood flow characteristics, such as real-time flow imaging, 2D multiple-venc phase contrast MRI, four-dimensional (4D) flow MRI, quantification of complex haemodynamic properties, and highly accelerated flow imaging. Emerging techniques and novel applications are explored. In addition, applications of these new techniques for the improved evaluation of cardiovascular (aorta, pulmonary arteries, congenital heart disease, atrial fibrillation, coronary arteries) as well as cerebrovascular disease (intra-cranial arteries and veins) are presented.
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45
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Hanneman K, Kino A, Cheng JY, Alley MT, Vasanawala SS. Assessment of the precision and reproducibility of ventricular volume, function, and mass measurements with ferumoxytol-enhanced 4D flow MRI. J Magn Reson Imaging 2016; 44:383-92. [PMID: 26871420 DOI: 10.1002/jmri.25180] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/19/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare the precision and interobserver agreement of ventricular volume, function, and mass quantification by 3D time-resolved (4D) flow MRI relative to cine steady-state free precession (SSFP). MATERIALS AND METHODS With Institutional Research Board approval, informed consent, and HIPAA compliance, 22 consecutive patients with congenital heart disease (CHD) (10 males, 6.4 ± 4.8 years) referred for 3T ferumoxytol-enhanced cardiac MRI were prospectively recruited. Complete ventricular coverage with standard 2D short-axis cine SSFP and whole chest coverage with axial 4D flow were obtained. Two blinded radiologists independently segmented images for left ventricular (LV) and right ventricular (RV) myocardium at end systole (ES) and end diastole (ED). Statistical analysis included linear regression, analysis of variance (ANOVA), Bland-Altman (BA) analysis, and intraclass correlation (ICC). RESULTS Significant positive correlations were found between 4D flow and SSFP for ventricular volumes (r = 0.808-0.972, P < 0.001), ejection fraction (EF) (r = 0.900-928, P < 0.001), and mass (r = 0.884-0.934, P < 0.001). BA relative limits of agreement for both ventricles were between -52% to 34% for volumes, -29% to 27% for EF, and -41% to 48% for mass, with wider limits of agreement for the RV compared to the LV. There was no significant difference between techniques with respect to mean square difference of ED-ES mass for either LV (F = 2.05, P = 0.159) or RV (F = 0.625, P = 0.434). Interobserver agreement was moderate to good with both 4D flow (ICC 0.523-0.993) and SSFP (ICC 0.619-0.982), with overlapping confidence intervals. CONCLUSION Quantification of ventricular volume, function, and mass can be accomplished with 4D flow MRI with precision and interobserver agreement comparable to that of cine SSFP. J. Magn. Reson. Imaging 2016;44:383-392.
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Affiliation(s)
- Kate Hanneman
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Aya Kino
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Joseph Y Cheng
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marcus T Alley
- Department of Radiology, Stanford University, Stanford, California, USA
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Sakata M, Takehara Y, Katahashi K, Sano M, Inuzuka K, Yamamoto N, Sugiyama M, Sakahara H, Wakayama T, Alley MT, Konno H, Unno N. Hemodynamic Analysis of Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair by Using 4-Dimensional Flow-Sensitive Magnetic Resonance Imaging. Circ J 2016; 80:1715-25. [DOI: 10.1253/circj.cj-16-0297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mayu Sakata
- Second Department of Surgery, Hamamatsu University School of Medicine
| | - Yasuo Takehara
- Department of Radiology, Hamamatsu University School of Medicine
| | - Kazuto Katahashi
- Second Department of Surgery, Hamamatsu University School of Medicine
| | - Masaki Sano
- Second Department of Surgery, Hamamatsu University School of Medicine
| | - Kazunori Inuzuka
- Second Department of Surgery, Hamamatsu University School of Medicine
| | - Naoto Yamamoto
- Second Department of Surgery, Hamamatsu University School of Medicine
| | | | - Harumi Sakahara
- Department of Radiology, Hamamatsu University School of Medicine
| | | | | | - Hiroyuki Konno
- Second Department of Surgery, Hamamatsu University School of Medicine
| | - Naoki Unno
- Second Department of Surgery, Hamamatsu University School of Medicine
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Cheng JY, Hanneman K, Zhang T, Alley MT, Lai P, Tamir JI, Uecker M, Pauly JM, Lustig M, Vasanawala SS. Comprehensive motion-compensated highly accelerated 4D flow MRI with ferumoxytol enhancement for pediatric congenital heart disease. J Magn Reson Imaging 2015; 43:1355-68. [PMID: 26646061 DOI: 10.1002/jmri.25106] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/14/2015] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To develop and evaluate motion-compensation and compressed-sensing techniques in 4D flow MRI for anatomical assessment in a comprehensive ferumoxytol-enhanced congenital heart disease (CHD) exam. MATERIALS AND METHODS A Cartesian 4D flow sequence was developed to enable intrinsic navigation and two variable-density sampling schemes: VDPoisson and VDRad. Four compressed-sensing methods were developed: A) VDPoisson scan reconstructed using spatial wavelets; B) added temporal total variation to A; C) VDRad scan using the same reconstruction as in B; and D) added motion compensation to C. With Institutional Review Board (IRB) approval and Health Insurance Portability and Accountability Act (HIPAA) compliance, 23 consecutive patients (eight females, mean 6.3 years) referred for ferumoxytol-enhanced CHD 3T MRI were recruited. Images were acquired and reconstructed using methods A-D. Two cardiovascular radiologists independently scored the images on a 5-point scale. These readers performed a paired wall motion and functional assessment between method D and 2D balanced steady-state free precession (bSSFP) CINE for 16 cases. RESULTS Method D had higher diagnostic image quality for most anatomical features (mean 3.8-4.8) compared to A (2.0-3.6), B (2.2-3.7), and C (2.9-3.9) with P < 0.05 with good interobserver agreement (κ ≥ 0.49). Method D had similar or better assessment of myocardial borders and cardiac motion compared to 2D bSSFP (P < 0.05, κ ≥ 0.77). All methods had good internal agreement in comparing aortic with pulmonic flow (BA mean < 0.02%, r > 0.85) and compared to method A (BA mean < 0.13%, r > 0.84) with P < 0.01. CONCLUSION Flow, functional, and anatomical assessment in CHD with ferumoxytol-enhanced 4D flow is feasible and can be significantly improved using motion compensation and compressed sensing. J. Magn. Reson. Imaging 2016;43:1355-1368.
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Affiliation(s)
- Joseph Y Cheng
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Kate Hanneman
- Department of Radiology, Stanford University, Stanford, California, USA.,University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tao Zhang
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marcus T Alley
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Peng Lai
- Global Applied Science Laboratory, GE Healthcare, Menlo Park, California, USA
| | - Jonathan I Tamir
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
| | - Martin Uecker
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
| | - John M Pauly
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Michael Lustig
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
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Hsiao A, Yousaf U, Alley MT, Lustig M, Chan FP, Newman B, Vasanawala SS. Improved quantification and mapping of anomalous pulmonary venous flow with four-dimensional phase-contrast MRI and interactive streamline rendering. J Magn Reson Imaging 2015; 42:1765-76. [PMID: 25914149 PMCID: PMC4843111 DOI: 10.1002/jmri.24928] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/07/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cardiac MRI is routinely performed for quantification of shunt flow in patients with anomalous pulmonary veins, but can be technically-challenging to perform. Four-dimensional phase-contrast (4D-PC) MRI has potential to simplify this exam. We sought to determine whether 4D-PC may be a viable clinical alternative to conventional 2D phase-contrast MR imaging. METHODS With institutional review board approval and HIPAA-compliance, we retrospectively identified all patients with anomalous pulmonary veins who underwent cardiac MRI at either 1.5 Tesla (T) or 3T with parallel-imaging compressed-sensing (PI-CS) 4D-PC between April, 2011 and October, 2013. A total of 15 exams were included (10 male, 5 female). Algorithms for interactive streamline visualization were developed and integrated into in-house software. Blood flow was measured at the valves, pulmonary arteries and veins, cavae, and any associated shunts. Pulmonary veins were mapped to their receiving atrial chamber with streamlines. The intraobserver, interobserver, internal consistency of flow measurements, and consistency with conventional MRI were then evaluated with Pearson correlation and Bland-Altman analysis. RESULTS Triplicate measurements of blood flow from 4D-PC were highly consistent, particularly at the aortic and pulmonary valves (cv 2-3%). Flow measurements were reproducible by a second observer (ρ = 0.986-0.999). Direct measurements of shunt volume from anomalous veins and intracardiac shunts matched indirect estimates from the outflow valves (ρ = 0.966). Measurements of shunt fraction using 4D-PC using any approach were more consistent with ventricular volumetric displacements than conventional 2D-PC (ρ = 0.972-0.991 versus 0.929). CONCLUSION Shunt flow may be reliably quantified with 4D-PC MRI, either indirectly or with detailed delineation of flow from multiple shunts. The 4D-PC may be a more accurate alternative to conventional MRI.
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Affiliation(s)
- Albert Hsiao
- Department of Radiology, University of California, San Diego, California, USA
| | - Ufra Yousaf
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marcus T. Alley
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Michael Lustig
- Department of Electrical Engineering and Computer Science, University of California, Berkeley, California, USA
| | - Frandics Pak Chan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Beverley Newman
- Department of Radiology, Stanford University, Stanford, California, USA
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Hollingsworth KG. Reducing acquisition time in clinical MRI by data undersampling and compressed sensing reconstruction. Phys Med Biol 2015; 60:R297-322. [PMID: 26448064 DOI: 10.1088/0031-9155/60/21/r297] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
MRI is often the most sensitive or appropriate technique for important measurements in clinical diagnosis and research, but lengthy acquisition times limit its use due to cost and considerations of patient comfort and compliance. Once an image field of view and resolution is chosen, the minimum scan acquisition time is normally fixed by the amount of raw data that must be acquired to meet the Nyquist criteria. Recently, there has been research interest in using the theory of compressed sensing (CS) in MR imaging to reduce scan acquisition times. The theory argues that if our target MR image is sparse, having signal information in only a small proportion of pixels (like an angiogram), or if the image can be mathematically transformed to be sparse then it is possible to use that sparsity to recover a high definition image from substantially less acquired data. This review starts by considering methods of k-space undersampling which have already been incorporated into routine clinical imaging (partial Fourier imaging and parallel imaging), and then explains the basis of using compressed sensing in MRI. The practical considerations of applying CS to MRI acquisitions are discussed, such as designing k-space undersampling schemes, optimizing adjustable parameters in reconstructions and exploiting the power of combined compressed sensing and parallel imaging (CS-PI). A selection of clinical applications that have used CS and CS-PI prospectively are considered. The review concludes by signposting other imaging acceleration techniques under present development before concluding with a consideration of the potential impact and obstacles to bringing compressed sensing into routine use in clinical MRI.
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Jaspan ON, Fleysher R, Lipton ML. Compressed sensing MRI: a review of the clinical literature. Br J Radiol 2015; 88:20150487. [PMID: 26402216 DOI: 10.1259/bjr.20150487] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
MRI is one of the most dynamic and safe imaging techniques available in the clinic today. However, MRI acquisitions tend to be slow, limiting patient throughput and limiting potential indications for use while driving up costs. Compressed sensing (CS) is a method for accelerating MRI acquisition by acquiring less data through undersampling of k-space. This has the potential to mitigate the time-intensiveness of MRI. The limited body of research evaluating the effects of CS on MR images has been mostly positive with regards to its potential as a clinical tool. Studies have successfully accelerated MRI with this technology, with varying degrees of success. However, more must be performed before its diagnostic efficacy and benefits are clear. Studies involving a greater number radiologists and images must be completed, rating CS based on its diagnostic efficacy. Also, standardized methods for determining optimal imaging parameters must be developed.
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Affiliation(s)
- Oren N Jaspan
- 1 Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Roman Fleysher
- 2 The Gruss Magnetic Resonance Research Center, Department of Radiology, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Michael L Lipton
- 3 The Gruss Magnetic Resonance Research Center, Departments of Radiology, Psychiatry and Behavioral Sciences and The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, The Bronx, NY, USA
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