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Zamani-Aliabadi SM, Qanadli SD, Fatehi-Feyzabad SH, Ghasemnezhad M, Ghaemi H, Azarine A, Mohammadzadeh A, Bitarafan-Rajabi A, Mortezaeian H, Rezaei-Kalantari K. Assessment of 4D flow MRI for quantification of left-to-right shunt in pediatric patients with ventricular septal defect: comparison with right heart catheterization. Front Cardiovasc Med 2024; 11:1399110. [PMID: 39105074 PMCID: PMC11298441 DOI: 10.3389/fcvm.2024.1399110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/10/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives The percentage of shunt fraction significantly impacts the management of patients with congenital shunts, influencing strategic choices such as surgical or interventional procedures. This study compared the estimated shunt fraction (the ratio of pulmonary-to-systemic flow, Qp/Qs) for quantifying the left-to-right shunt in children with ventricular septal defect (VSD) using heart catheterization, four-dimensional (4D) flow, and two-dimensional (2D) flow magnetic resonance imaging (MRI). The goal was to establish a non-invasive and reliable measurement ratio between pulmonary and systemic blood flow in these patients. Methods Between July 2022 and June 2023, patients scheduled to undergo invasive right heart catheterization were included in this study. MRI was performed one hour before the catheterization procedure. The correlation of shunt fraction was assessed between all methods after calculating the Qp/Qs ratio from 2D and 4D flow MRI and catheterization. Results A total of 24 patients (aged 3-15 years, eight females) were ultimately included in the study. The Qp/Qs ratios obtained from 4D flow had a robust correlation (correlation coefficient r = 0.962) compared to those obtained during catheterization. Cardiac catheterization recorded the mean shunt fraction at 1.499 ± 0.396, while 4D flow measured it at 1.403 ± 0.344, with no significant difference between the two techniques. Moreover, there was a reasonable correlation (r = 0.894) between 2D flow measurements of Qp/Qs and the results obtained from catheterization, with a mean shunt fraction of 1.326 ± 0.283. Conclusion 4D flow MRI has the potential to be a non-invasive method for accurately measuring the left-to-right shunt in children with VSD.
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Affiliation(s)
| | - Salah D. Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Seyed Hasan Fatehi-Feyzabad
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ghasemnezhad
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Ghaemi
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arshid Azarine
- Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, Paris, France
| | - Ali Mohammadzadeh
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Bitarafan-Rajabi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hojjat Mortezaeian
- Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Valdeolmillos E, Sakhi H, Tortigue M, Audié M, Isorni MA, Lecerf F, Sitbon O, Montani D, Jais X, Savale L, Humbert M, Azarine A, Hascoët S. 4D flow cardiac MRI to assess pulmonary blood flow in patients with pulmonary arterial hypertension associated with congenital heart disease. Diagn Interv Imaging 2024; 105:266-272. [PMID: 38368175 DOI: 10.1016/j.diii.2024.01.009] [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: 11/06/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of four-dimensional flow cardiac magnetic resonance imaging (4D flow MRI) compared to right heart catheterization in measuring pulmonary flow (Qp), systemic flow (Qs) and pulmonary-to-systemic flow ratio (Qp/Qs) in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). MATERIALS AND METHODS The study was registered on Clinical-trial.gov (NCT03928002). Sixty-four patients with PAH-CHD who underwent 4D flow MRI were included. There were 16 men and 48 women with a mean age of 45.3 ± 13.7 (standard deviation [SD]) years (age range: 21-77 years). Fifty patients (50/64; 78%) presented with pre-tricuspid shunt. Qp (L/min), Qs (L/min) and Qp/Qs were measured invasively using direct Fick method during right heart catheterization and compared with measurements assessed by 4D flow MRI within a 24-48-hour window. RESULTS The average mean pulmonary artery pressure was 51 ± 17 (SD) mm Hg with median pulmonary vascular resistance of 8.8 Wood units (Q1, Q3: 5.3, 11.7). A strong linear correlation was found between Qp measurements obtained with 4D flow MRI and those obtained with the Fick method (r = 0.96; P < 0.001). Bland Altman analysis indicated a mean difference of 0.15 ± 0.48 (SD) L/min between Qp estimated by 4D flow MRI and by right heart catheterization. A strong correlation was found between Qs and Qp/Qs measured by 4D flow MRI and those obtained with the direct Fick method (r = 0.85 and r = 0.92; P < 0.001 for both). CONCLUSION Qp as measured by 4D flow MRI shows a strong correlation with measurements derived from the direct Fick method. Further investigation is needed to develop less complex and standardized methods for measuring essential PAH parameters, such as pulmonary arterial pressures and pulmonary vascular resistance.
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Affiliation(s)
- Estibaliz Valdeolmillos
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France.
| | - Hichem Sakhi
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Department of Cardiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Marine Tortigue
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Marion Audié
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Marc-Antoine Isorni
- Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Florence Lecerf
- Research and Innovation Department, Marie Lannelongue Hospital, Paris Saclay University, 92350 Le Plessis-Robinson, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Xavier Jais
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Arshid Azarine
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
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Ozawa Y, Nagata H, Ueda T, Oshima Y, Hamabuchi N, Yoshikawa T, Takenaka D, Ohno Y. Chest Magnetic Resonance Imaging: Advances and Clinical Care. Clin Chest Med 2024; 45:505-529. [PMID: 38816103 DOI: 10.1016/j.ccm.2024.02.017] [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] [Indexed: 06/01/2024]
Abstract
Many promising study results as well as technical advances for chest magnetic resonance imaging (MRI) have demonstrated its academic and clinical potentials during the last few decades, although chest MRI has been used for relatively few clinical situations in routine clinical practice. However, the Fleischner Society as well as the Japanese Society of Magnetic Resonance in Medicine have published a few white papers to promote chest MRI in routine clinical practice. In this review, we present clinical evidence of the efficacy of chest MRI for 1) thoracic oncology and 2) pulmonary vascular diseases.
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Affiliation(s)
- Yoshiyuki Ozawa
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Ueda
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takeshi Yoshikawa
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Daisuke Takenaka
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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Moscatelli S, Avesani M, Borrelli N, Sabatino J, Pergola V, Leo I, Montanaro C, Contini FV, Gaudieri G, Ielapi J, Motta R, Merrone MA, Di Salvo G. Complete Transposition of the Great Arteries in the Pediatric Field: A Multimodality Imaging Approach. CHILDREN (BASEL, SWITZERLAND) 2024; 11:626. [PMID: 38929206 PMCID: PMC11202141 DOI: 10.3390/children11060626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
The complete transposition of the great arteries (C-TGA) is a congenital cardiac anomaly characterized by the reversal of the main arteries. Early detection and precise management are crucial for optimal outcomes. This review emphasizes the integral role of multimodal imaging, including fetal echocardiography, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT) in the diagnosis, treatment planning, and long-term follow-up of C-TGA. Fetal echocardiography plays a pivotal role in prenatal detection, enabling early intervention strategies. Despite technological advances, the detection rate varies, highlighting the need for improved screening protocols. TTE remains the cornerstone for initial diagnosis, surgical preparation, and postoperative evaluation, providing essential information on cardiac anatomy, ventricular function, and the presence of associated defects. CMR and CCT offer additional value in C-TGA assessment. CMR, free from ionizing radiation, provides detailed anatomical and functional insights from fetal life into adulthood, becoming increasingly important in evaluating complex cardiac structures and post-surgical outcomes. CCT, with its high-resolution imaging, is indispensable in delineating coronary anatomy and vascular structures, particularly when CMR is contraindicated or inconclusive. This review advocates for a comprehensive imaging approach, integrating TTE, CMR, and CCT to enhance diagnostic accuracy, guide therapeutic interventions, and monitor postoperative conditions in C-TGA patients. Such a multimodal strategy is vital for advancing patient care and improving long-term prognoses in this complex congenital heart disease.
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Affiliation(s)
- Sara Moscatelli
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London WC1E 6BT, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Jolanda Sabatino
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Valeria Pergola
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University Hospital of Padua, 35128 Padua, Italy; (V.P.)
| | - Isabella Leo
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Claudia Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
- CMR Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 5NP, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Francesca Valeria Contini
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University Hospital of Cagliari, Strada Statale 554, Km 4.500, 09042 Monserrato, Italy
- Pediatric Cardiology and Congenital Heart Disease Unit, Brotzu Hospital, 09134 Cagliari, Italy
| | - Gabriella Gaudieri
- Adult Congenital Heart Disease Unit, AO Dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Jessica Ielapi
- Experimental and Clinical Medicine Department, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy (I.L.)
| | - Raffaella Motta
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, University Hospital of Padua, 35128 Padua, Italy; (V.P.)
| | - Marco Alfonso Merrone
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
- Division of Cardiology and Cardio Lab, Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women and Children’s Health, University Hospital of Padua, 35128 Padua, Italy
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Bi J, Li Z, Zhang X, Bai X, Zhao X, Qu H, Kong Q, An J, Mo D, Sui B. Differentiation Between the Low and High Trans-Stenotic Pressure Gradient in Patients With Idiopathic Intracranial Hypertension Using 4D Flow MRI-Derived Hemodynamic Parameters. J Magn Reson Imaging 2024; 59:1569-1579. [PMID: 37578214 DOI: 10.1002/jmri.28959] [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: 01/06/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Trans-stenotic pressure gradient (TPG) measurement is essential for idiopathic intracranial hypertension (IIH) patients with transverse sinus (TS) stenosis. Four-D flow MRI may provide a noninvasive imaging method for differentiation of IIH patients with different TPG. PURPOSE To investigate the associations between 4D flow parameters and TPG, and to evaluate the diagnostic performance of 4D flow parameters in differentiating patients with high TPG (GroupHP) from low TPG (GroupLP). STUDY TYPE Prospective. POPULATION 31 IIH patients with TS stenosis (age, 38 ± 12 years; 23 females) and 5 healthy volunteers (age, 25 ± 1 years; 2 females). FIELD STRENGTH/SEQUENCE 3T, 3D phase contrast MR venography, and gradient recalled echo 4D flow sequences. ASSESSMENT Scan-rescan reproducibility of 4D flow parameters were performed. The correlation between TPG and flow parameters was analyzed. The netflow and velocity difference between inflow plane, outflow plane, and the stenosis plane were calculated and compared between GroupHP and GroupLP. STATISTICAL TESTS Pearson's correlation or Spearman's rank correlation coefficient, Independent samples t-test or Wilcoxon rank-sum test, Intra-class correlation coefficient (ICC), Bland-Altman analyses, Receiver operating characteristic curves. A P value <0.05 was considered significant. RESULTS Significant correlations were found between TPG and netflow parameters including Favg,out-s, Favg,in-s, Fmax,out-s, and Fmax,in-s (r = 0.525-0.565). Significant differences were found in Favg,out-s, Fmax,out-s, Favg,in-s, and Fmax,in-s between GroupHP and GroupLP. Using the cut-off value of 2.19 mL/sec, the Favg,out-s showed good estimate performance in distinguishing GroupHP from GroupLP (AUC = 0.856). The ICC (ranged 0.905-0.948) and Bland-Altman plots indicated good scan-rescan reproducibility. DATA CONCLUSIONS 4D flow MRI derived flow parameters showed good correlations with TPG in IIH patients with TS stenosis. Netflow difference between outflow and stenosis location at TS shows the good performance in differentiating GroupHP and GroupLP cases. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jingfeng Bi
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhiye Li
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qingle Kong
- MR Collaboration, Siemens Healthineers Ltd, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Wada A, Akatsu T, Ikenouchi Y, Suzuki M, Akashi T, Hagiwara A, Nishizawa M, Sano K, Kamagata K, Aoki S. Synthesizing 4D Magnetic Resonance Angiography From 3D Time-of-Flight Using Deep Learning: A Feasibility Study. Cureus 2024; 16:e60803. [PMID: 38910733 PMCID: PMC11190969 DOI: 10.7759/cureus.60803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/25/2024] Open
Abstract
Objective and background This study aimed to develop a deep convolutional neural network (DCNN) model capable of generating synthetic 4D magnetic resonance angiography (MRA) from 3D time-of-flight (TOF) images, allowing estimation of temporal changes in arterial flow. TOF MRA provides static information about arterial structures through maximum intensity projection (MIP) processing, but it does not capture the dynamic information of contrast agent circulation, which is lost during MIP processing. Considering the principles of TOF, it is hypothesized that dynamic information about arterial blood flow is latent within TOF signals. Although arterial spin labeling (ASL) can extract dynamic arterial information, ASL MRA has drawbacks, such as longer imaging times and lower spatial resolution than TOF MRA. This study's primary aim is to extend the utility of TOF MRA by training a machine-learning model on paired TOF and ASL data to extract latent dynamic information from TOF signals. Methods A DCNN combining a modified U-Net and a long-short-term memory (LSTM) network was trained on a dataset of 13 subjects (11 men and two women, aged 42-77 years) using paired 3D TOF MRA and 4D ASL MRA images. Subjects had no history of cerebral vessel occlusion or significant stenosis. The dataset was acquired using a 3T MRI system with a 32-channel head coil. Preprocessing involved resampling and intensity normalization of TOF and ASL images, followed by data augmentation and arterial mask generation. The model learned to extract flow information from TOF images and generate 8-phase 4D MRA images. The precision of flow estimation was evaluated using the coefficient of determination (R²) and Bland-Altman analysis. A board-certified neuroradiologist validated the quality of the images and the absence of significant stenosis in the major cerebral arteries. Results The generated 4D MRA images closely resembled the ground-truth ASL MRA data, with R² values of 0.92, 0.85, and 0.84 for the internal carotid artery (ICA), proximal middle cerebral artery (MCA), and distal MCA, respectively. Bland-Altman analysis revealed a systematic error of -0.06, with 95% agreement limits ranging from -0.18 to 0.12. Additionally, the model successfully identified flow abnormalities in a subject with left MCA stenosis, displaying a delayed peak and subsequent flattening distal to the stenosis, indicative of reduced blood flow. Visualization of the predicted arterial flow overlaid on the original TOF MRA images highlighted the spatial progression and dynamics of the flow. Conclusions The DCNN model effectively generated synthetic 4D MRA images from TOF images, demonstrating its potential to estimate temporal changes in arterial flow accurately. This non-invasive technique offers a promising alternative to conventional methods for visualizing and evaluating healthy and pathological flow dynamics. It has significant potential to improve the diagnosis and treatment of cerebrovascular diseases by providing detailed temporal flow information without the need for contrast agents or invasive procedures. The practical implementation of this model could enable the extraction of dynamic cerebral blood flow information from routine brain MRI examinations, contributing to the early diagnosis and management of cerebrovascular disorders.
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Affiliation(s)
- Akihiko Wada
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Toshiya Akatsu
- Department of Radiology, Juntendo University Hospital, Tokyo, JPN
| | - Yutaka Ikenouchi
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University Urayasu Hospital, Chiba, JPN
| | - Toshiaki Akashi
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Mitsuo Nishizawa
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Katsuhiro Sano
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, JPN
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7
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Jack JT, Jensen M, Collins RT, Chan FP, Millett PC. Numerical study of hemodynamic flow in the aortic vessel of Williams syndrome patient with congenital heart disease. J Biomech 2024; 168:112124. [PMID: 38701696 DOI: 10.1016/j.jbiomech.2024.112124] [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: 12/13/2023] [Revised: 04/01/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
Congenital arterial stenosis such as supravalvar aortic stenosis (SVAS) are highly prevalent in Williams syndrome (WS) and other arteriopathies pose a substantial health risk. Conventional tools for severity assessment, including clinical findings and pressure gradient estimations, often fall short due to their susceptibility to transient physiological changes and disease stage influences. Moreover, in the pediatric population, the severity of these and other congenital heart defects (CHDs) often restricts the applicability of invasive techniques for obtaining crucial physiological data. Conversely, evaluating CHDs and their progression requires a comprehensive understanding of intracardiac blood flow. Current imaging modalities, such as blood speckle imaging (BSI) and four-dimensional magnetic resonance imaging (4D MRI) face limitations in resolving flow data, especially in cases of elevated flow velocities. To address these challenges, we devised a computational framework employing zero-dimensional (0D) lumped parameter models coupled with patient-specific reconstructed geometries pre- and post-surgical intervention to execute computational fluid dynamic (CFD) simulations. This framework facilitates the analysis and visualization of intricate blood flow patterns, offering insights into geometry and flow dynamics alterations impacting cardiac function. In this study, we aim to assess the efficacy of surgical intervention in correcting an extreme aortic defect in a patient with WS, leading to reductions in wall shear stress (WSS), maximum velocity magnitude, pressure drop, and ultimately a decrease in cardiac workload.
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Affiliation(s)
- Justin T Jack
- University of Arkansas, Department of Mechanical Engineering, Fayetteville, AR, USA
| | - Morten Jensen
- University of Arkansas, Department of Biomedical Engineering, Fayetteville, AR, USA; University of Arkansas for Medical Sciences, Department of Surgery, Little Rock, AR, USA
| | - R Thomas Collins
- University of Kentucky, Department of Pediatrics, Division of Cardiology, Lexington, KY, USA
| | - Frandics Pak Chan
- Stanford University, Department of Radiology/Cardiovascular Imaging, Palo Alto, CA, USA
| | - Paul C Millett
- University of Arkansas, Department of Mechanical Engineering, Fayetteville, AR, USA.
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Bellala AP, Valakkada J, Ayappan A, Kannath S, Shivanesan P. False lumen regurgitation fraction and energy loss in the aorta measured using four-dimensional flow MRI to predict expansion of acute uncomplicated type B aortic dissection: a prospective study. Clin Radiol 2024; 79:e616-e623. [PMID: 38310057 DOI: 10.1016/j.crad.2023.12.007] [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: 09/08/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 02/05/2024]
Abstract
AIM To assess the relationship between four-dimensional (4D)-flow-derived false lumen regurgitation fraction (FLRF) and energy loss (EL) percentage in the descending thoracic aorta (DTA) with the aortic growth rate in uncomplicated type B aortic dissection (uTBAD). METHODS AND MATERIALS In this prospective study performed on 15 patients with uTBAD, computed tomography (CT) angiography and 4D-flow magnetic resonance imaging (MRI) were performed at the initial presentation with follow-up CT at 2 years. 4D-flow parameters, including maximum peak systolic velocity (PSV), FLRF, and percentage of EL were measured using Circle CV42. The significance of these parameters for expansion (>3 mm/year) of aortic dissection was analysed. RESULTS Five patients had an enlarging aorta, while 10 had a stable aortic size. The Mann-Whitney U-test showed entry tear >10 mm (p=0.026), FLRF (7.6 ± 8.9 versus 64.8 ± 16.7%; p=0.002), EL in the DTA in (1.61 ± 1.99 versus 2.21 ± 0.32 μW/cm3; p=0.014) and percentage of EL in the DTA to overall energy loss from the ascending aorta to the DTA (37 ± 15% versus 66 ± 17%; p=0.005), having a statistically significant different expanding stable dissection. A positive significant Spearman correlation was noted with the aortic growth rate (in millimetres over 2 years) with FLRF (r=0.71, p=0.003), EL in the DTA (r=0.56, p=0.007), and percentage of EL in the DTA (r=0.62, p=0.003). CONCLUSION 4D flow parameters, including FLRF and the percentage amount of EL in the DTA may help predict aortic growth at an early stage in uTBAD.
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Affiliation(s)
- A P Bellala
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India
| | - J Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India.
| | - A Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India
| | - S Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India
| | - P Shivanesan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India; Department of Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, Kerala, India
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9
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Chevance V, Azarine A, Hamon DA, Dhanjal TS, Teiger E, Deux JF, Lellouche N. Wall shear stress in outflow tract premature ventricular contraction location assessed through 4D-flow MRI. Europace 2024; 26:euae034. [PMID: 38290435 PMCID: PMC10849830 DOI: 10.1093/europace/euae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Virgile Chevance
- Radiology Department, Hopital Henri Mondor, APHP, Creteil, France
- Radiology Department, Centre Chirurgical Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Arshid Azarine
- Radiology Department, Centre Chirurgical Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - David A Hamon
- Cardiology and Electrophysiology Unit, Hopital Henri Mondor, APHP, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
- University of Iowa Hospitals and Clinics (UIHC), Department of Cardiology, Carver College of Medicine, Iowa City, IA
| | - Tarvinder S Dhanjal
- Department of Cardiac Electrophysiology, University of Warwick, Gibbet Hill, Coventry, UK
| | - Emmanuel Teiger
- Cardiology and Electrophysiology Unit, Hopital Henri Mondor, APHP, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Jean-François Deux
- Radiology Department, Hopital Henri Mondor, APHP, Creteil, France
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas Lellouche
- Cardiology and Electrophysiology Unit, Hopital Henri Mondor, APHP, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
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10
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Ohno Y, Ozawa Y, Nagata H, Ueda T, Yoshikawa T, Takenaka D, Koyama H. Lung Magnetic Resonance Imaging: Technical Advancements and Clinical Applications. Invest Radiol 2024; 59:38-52. [PMID: 37707840 DOI: 10.1097/rli.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
ABSTRACT Since lung magnetic resonance imaging (MRI) became clinically available, limited clinical utility has been suggested for applying MRI to lung diseases. Moreover, clinical applications of MRI for patients with lung diseases or thoracic oncology may vary from country to country due to clinical indications, type of health insurance, or number of MR units available. Because of this situation, members of the Fleischner Society and of the Japanese Society for Magnetic Resonance in Medicine have published new reports to provide appropriate clinical indications for lung MRI. This review article presents a brief history of lung MRI in terms of its technical aspects and major clinical indications, such as (1) what is currently available, (2) what is promising but requires further validation or evaluation, and (3) which developments warrant research-based evaluations in preclinical or patient studies. We hope this article will provide Investigative Radiology readers with further knowledge of the current status of lung MRI and will assist them with the application of appropriate protocols in routine clinical practice.
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Affiliation(s)
- Yoshiharu Ohno
- From the Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y. Ohno); Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y. Ohno and H.N.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y. Ozawa and T.U.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan (T.Y., D.T.); and Department of Radiology, Advanced Diagnostic Medical Imaging, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (H.K.)
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11
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Yi W, Otani T, Yoshida T, Endo S, Wada S. Computational study on hemodynamic effects of left superior pulmonary vein resection and associated physiological changes in the left atrium after left upper lobectomy. Comput Methods Biomech Biomed Engin 2024; 27:167-178. [PMID: 36790387 DOI: 10.1080/10255842.2023.2178258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
Left upper lobectomy (LUL) with left superior pulmonary vein (LSPV) resection alters the left atrium (LA) physiological states and LA hemodynamics associated with thrombosis, although this underlying mechanism is poorly understood. Therefore, we investigated the effects of LSPV resection and associated LA physiological changes on LA hemodynamics using four-dimensional computed tomography image-based computational simulations. Three cases were considered: the LA before and after LUL extracted from computed tomography images and artificial LSPV resection without physiological changes. Comparisons among the three cases demonstrated that physiological changes associated with LSPV resection are the possible factors that affect the LA hemodynamics after LUL.
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Affiliation(s)
- Wentao Yi
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Tomohiro Otani
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Takuya Yoshida
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Shunsuke Endo
- Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Shiego Wada
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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12
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Panjwani B, Singh A, Shah A. CT and MR Imaging for Atrial Septal Defect Repair. Semin Roentgenol 2024; 59:103-111. [PMID: 38388089 DOI: 10.1053/j.ro.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | | | - Amar Shah
- North Shore University Hospital, Manhasset, NY
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13
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Ebrahimkhani M, Johnson EMI, Sodhi A, Robinson JD, Rigsby CK, Allen BD, Markl M. A Deep Learning Approach to Using Wearable Seismocardiography (SCG) for Diagnosing Aortic Valve Stenosis and Predicting Aortic Hemodynamics Obtained by 4D Flow MRI. Ann Biomed Eng 2023; 51:2802-2811. [PMID: 37573264 DOI: 10.1007/s10439-023-03342-7] [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: 03/26/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
In this paper, we explored the use of deep learning for the prediction of aortic flow metrics obtained using 4-dimensional (4D) flow magnetic resonance imaging (MRI) using wearable seismocardiography (SCG) devices. 4D flow MRI provides a comprehensive assessment of cardiovascular hemodynamics, but it is costly and time-consuming. We hypothesized that deep learning could be used to identify pathological changes in blood flow, such as elevated peak systolic velocity ([Formula: see text]) in patients with heart valve diseases, from SCG signals. We also investigated the ability of this deep learning technique to differentiate between patients diagnosed with aortic valve stenosis (AS), non-AS patients with a bicuspid aortic valve (BAV), non-AS patients with a mechanical aortic valve (MAV), and healthy subjects with a normal tricuspid aortic valve (TAV). In a study of 77 subjects who underwent same-day 4D flow MRI and SCG, we found that the [Formula: see text] values obtained using deep learning and SCGs were in good agreement with those obtained by 4D flow MRI. Additionally, subjects with non-AS TAV, non-AS BAV, non-AS MAV, and AS could be classified with ROC-AUC (area under the receiver operating characteristic curves) values of 92%, 95%, 81%, and 83%, respectively. This suggests that SCG obtained using low-cost wearable electronics may be used as a supplement to 4D flow MRI exams or as a screening tool for aortic valve disease.
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Affiliation(s)
- Mahmoud Ebrahimkhani
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Ethan M I Johnson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Aparna Sodhi
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, 60611, USA
| | - Joshua D Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Cynthia K Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Bradly D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, 60208, USA.
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14
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Schäfer M, Mawad W. Advanced Imaging Technologies for Assessing Tetralogy of Fallot: Insights Into Flow Dynamics. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:380-392. [PMID: 38161669 PMCID: PMC10755841 DOI: 10.1016/j.cjcpc.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect requiring surgical repair. Although surgical interventions have significantly reduced mortality, postrepair complications, such as pulmonary valve regurgitation and stenosis, may lead to adverse outcomes, including right ventricular dysfunction and increased risks of morbidity and mortality. This review explores the potential of advanced imaging technologies, including 4-dimensional-flow magnetic resonance imaging and high-frame-rate echocardiography, in providing valuable insights into blood flow dynamics and energy parameters. Quantitative measures, such as energy loss and vorticity, along with qualitative flow analysis, can provide additional insights into adverse haemodynamics at a potentially earlier and more reversible stage. Furthermore, personalized patient-specific information from these imaging modalities aids in guiding treatment decisions and monitoring postoperative interventions effectively. By characterizing flow patterns, these advanced imaging techniques hold great promise in improving the assessment and management of tetralogy of Fallot, providing tailored insights. However, further research and longitudinal studies are required to fully establish their clinical utility and potential impact on patient care.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Wadi Mawad
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Québec, Canada
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15
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Henry M, Fadnes S, Lovstakken L, Mawad W, Mertens L, Nyrnes SA. Flow Dynamics in Children With Bicuspid Aortic Valve: A Blood Speckle Tracking Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2354-2360. [PMID: 37573177 DOI: 10.1016/j.ultrasmedbio.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Bicuspid aortic valve (BAV) is associated with progressive aortic dilation. Although the etiology is complex, altered flow dynamics is thought to play an important role. Blood speckle tracking (BST) allows for visualization and quantification of complex flow, which could be useful in identifying patients at risk of root dilation and could aid in surgical planning. The aims of this study were to assess and quantify flow in the aortic root and left ventricle using BST in children with bicuspid aortic valves. METHODS AND RESULTS A total of 38 children <10 y of age were included (24 controls, 14 with BAV). Flow dynamics were examined using BST in the aortic root and left ventricle. Children with BAV had altered systolic flow patterns in the aortic root and higher aortic root average vorticity (25.9 [23.4-29.2] Hz vs. 17.8 [9.0-26.2] Hz, p < 0.05), vector complexity (0.17 [0.14-0.31] vs. 0.05 [0.02-0.13], p < 0.01) and rate of energy loss (7.9 [4.9-12.1] mW/m vs. 2.7 [1.2-7.4] mW/m, p = 0.01). Left ventricular average diastolic vorticity (20.9 ± 5.8 Hz vs. 11.4 ± 5.2 Hz, p < 0.01), kinetic energy (0.11 ± 0.05 J/m vs. 0.04 ± 0.02 J/m, p < 0.01), vector complexity (0.38 ± 0.1 vs. 0.23 ± 0.1, p < 0.01) and rate of energy loss (11.1 ± 4.8 mW/m vs. 2.7 ± 1.9 mW/m, p < 0.01) were higher in children with BAV. CONCLUSION Children with BAV exhibit altered flow dynamics in the aortic root and left ventricle in the absence of significant aortic root dilation. This may represent a substrate and potential predictor for future dilation and diastolic dysfunction.
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Affiliation(s)
| | - Solveig Fadnes
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Lasse Lovstakken
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Wadi Mawad
- McGill University Health Centre, Montreal, QC, Canada
| | - Luc Mertens
- Hospital for Sick Children, Toronto, ON, Canada
| | - Siri Ann Nyrnes
- Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olav's University Hospital, Trondheim, Norway
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16
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Li N, Tous C, Dimov IP, Fei P, Zhang Q, Lessard S, Tang A, Martel S, Soulez G. Design of a Low-Cost, Self-Adaptive and MRI-Compatible Cardiac Gating System. IEEE Trans Biomed Eng 2023; 70:3126-3136. [PMID: 37276095 DOI: 10.1109/tbme.2023.3280348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Cardiac gating, synchronizing medical scans with cardiac activity, is widely used to make quantitative measurements of physiological events and to obtain high-quality scans free of pulsatile artefacts. This can provide important information for disease diagnosis, targeted control of medical microrobots, etc. The current work proposes a low-cost, self-adaptive, MRI-compatible cardiac gating system. METHOD The system and its processing algorithm, based on the monitoring and analysis of blood pressure waveforms, are proposed. The system is tested in an in vitro experiment and two living pigs using four-dimensional (4D) flow magnetic resonance imaging (MRI) and two-dimensional phase-contrast (2D-PC) sequences. RESULTS in vitro and in vivo experiments reveal that the proposed system can provide stable cardiac synchronicity, has good MRI compatibility, and can cope with the fringe magnetic field of the MRI scanner, radiofrequency signals during image acquisition, and heart rate changes. High-resolution 4D flow imaging is successfully acquired both in vivo and in vitro. The difference between the 2D and 4D measurements is ≤ 21%. The incidence of false triggers is 0% in all tests, which is unattainable for other known cardiac gating methods. CONCLUSION The system has good MRI compatibility and can provide a stable and accurate trigger signal based on pressure waveform. It opens the door to applications where the previous gating methods were difficult to implement or not applicable.
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17
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Karsenty C, Alattar Y, Mousseaux E, Marcilhacy G, Gencer U, Craiem D, Iserin L, Ladouceur M, Legendre A, Laredo M, Bonnet D, Malekzadeh-Milani S, Soulat G. 4D flow magnetic resonance imaging to assess right ventricular outflow tract in patients undergoing transcatheter pulmonary valve replacement. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:793-802. [PMID: 36921915 DOI: 10.1016/j.rec.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI) including 4D flow is used before percutaneous pulmonary valve implantation (PPVI). As PPVI is limited by the size of the right ventricular outflow tract (RVOT), accurate sizing is needed to plan the intervention. The aim of this study was to compare different MRI modalities and invasive angiography to balloon sizing of RVOT. METHODS Single-center prospective study of patients who underwent PPVI for isolated pulmonary regurgitation assessed by 4D flow MRI, 3D steady-state free precession/gradient echo (3D SSFP/GRE) and contrast magnetic resonance angiography. Balloon sizing was considered as the reference. RESULTS A total of 23 adults were included (mean age, 38.4±12.5 years). Eighteen patients underwent successful primary PPVI. The average of the narrowest RVOT diameter was 25.4±4.3 mm by balloon sizing. Compared to balloon sizing, RVOT diameters were better correlated when estimated by systolic 4D flow MRI (r=0.89, P<.001) than by diastolic 4D flow MRI (r=0.71, P <.001), 3D contrast magnetic resonance angiography (r=0.73; P <.001) and 3D SSFP/GRE (r=0.50; P=.04) and was not significantly correlated when estimated by 2D in diastole and systole. The mean difference between systolic 4D flow MRI and balloon sizing was 0.2 mm (95%CI, -3.5 to 3.9 mm), whereas it was wider with other techniques. CONCLUSIONS Beyond the quantification of pulmonary valve regurgitation, 4D flow allows accurate estimation of RVOT diameters, especially in systole, which is fundamental before planning PPVI.
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Affiliation(s)
- Clément Karsenty
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Pediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Toulouse, France; Adult Congenital Cardiology Department, Clinique Pasteur, Toulouse, France.
| | - Yousef Alattar
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Elie Mousseaux
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
| | - Gabrielle Marcilhacy
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Umit Gencer
- Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
| | - Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Laurence Iserin
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Magalie Ladouceur
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
| | - Antoine Legendre
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Mikael Laredo
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Institut de Cardiologie, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Bonnet
- Pediatric and Congenital Department, M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France; Institut IMAGINE, Université de Paris, Paris, France
| | - Sophie Malekzadeh-Milani
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Pediatric and Congenital Department, M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Gilles Soulat
- Adult Congenital Cardiology Department, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) Paris, France
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Burkhardt BEU, Kellenberger CJ, Callaghan FM, Valsangiacomo Buechel ER, Geiger J. Flow evaluation software for four-dimensional flow MRI: a reliability and validation study. LA RADIOLOGIA MEDICA 2023; 128:1225-1235. [PMID: 37620674 PMCID: PMC10547653 DOI: 10.1007/s11547-023-01697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Four-dimensional time-resolved phase-contrast cardiovascular magnetic resonance imaging (4D flow MRI) enables blood flow quantification in multiple vessels, which is crucial for patients with congenital heart disease (CHD). We investigated net flow volumes in the ascending aorta and pulmonary arteries by four different postprocessing software packages for 4D flow MRI in comparison with 2D cine phase-contrast measurements (2D PC). MATERIAL AND METHODS 4D flow and 2D PC datasets of 47 patients with biventricular CHD (median age 16, range 0.6-52 years) were acquired at 1.5 T. Net flow volumes in the ascending aorta, the main, right, and left pulmonary arteries were measured using four different postprocessing software applications and compared to offset-corrected 2D PC data. Reliability of 4D flow postprocessing software was assessed by Bland-Altman analysis and intraclass correlation coefficient (ICC). Linear regression of internal flow controls was calculated. Interobserver reproducibility was evaluated in 25 patients. RESULTS Correlation and agreement of flow volumes were very good for all software compared to 2D PC (ICC ≥ 0.94; bias ≤ 5%). Internal controls were excellent for 2D PC (r ≥ 0.95, p < 0.001) and 4D flow (r ≥ 0.94, p < 0.001) without significant difference of correlation coefficients between methods. Interobserver reliability was good for all vendors (ICC ≥ 0.94, agreement bias < 8%). CONCLUSION Haemodynamic information from 4D flow in the large thoracic arteries assessed by four commercially available postprocessing applications matches routinely performed 2D PC values. Therefore, we consider 4D flow MRI-derived data ready for clinical use in patients with CHD.
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Affiliation(s)
- Barbara Elisabeth Ursula Burkhardt
- Paediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zürich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland.
| | - Christian Johannes Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
| | - Fraser Maurice Callaghan
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
| | - Emanuela Regina Valsangiacomo Buechel
- Paediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zürich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
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Sharma A, Vadher A, Shaw M, Malhi AS, Kumar S, Singhal M. Basic Concepts and Insights into Aortopulmonary Collateral Arteries in Congenital Heart Diseases. Indian J Radiol Imaging 2023; 33:496-507. [PMID: 37811182 PMCID: PMC10556305 DOI: 10.1055/s-0043-1770344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Aortopulmonary collateral arteries are persistent embryological vessels supplying lung parenchyma in various cardiopulmonary diseases with underlying pulmonary hypoperfusion. Their identification and mapping are important because of associated clinical implications and tendency to affect the surgical outcome. This article describes the embryological development and clinical relevance of aortopulmonary collaterals in various congenital cardiopulmonary conditions, along with the significance for treatment planning. Roles, strength, and shortcomings of the various imaging options and image-guided interventions are discussed, with a focus on presurgical planning and preparation, as well as postsurgical management.
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Affiliation(s)
- Arun Sharma
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akash Vadher
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder S. Malhi
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Pergola V, Avesani M, Reffo E, Da Pozzo S, Cavaliere A, Padalino M, Vida V, Motta R, Di Salvo G. Unveiling the gothic aortic arch and cardiac mechanics: insights from young patients after arterial switch operation for d-transposition of the great arteries. Monaldi Arch Chest Dis 2023; 94. [PMID: 37768214 DOI: 10.4081/monaldi.2023.2712] [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: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The arterial switch operation (ASO) has become the standard surgical treatment for patients with d-transposition of the great arteries. While ASO has significantly improved survival rates, a subset of patients develop a unique anatomical anomaly known as the gothic aortic arch (GAA). Understanding cardiac mechanics in this population is crucial, as altered mechanics can have profound consequences for cardiac function and exercise capacity. The GAA has been associated with changes in ventricular function, hemodynamics, and exercise capacity. Studies have shown a correlation between the GAA and decreased ascending aorta distensibility, loss of systolic wave amplitude across the aortic arch, and adverse cardiovascular outcomes. Various imaging techniques, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, play a crucial role in assessing cardiac mechanics and evaluating the GAA anomaly. Despite significant advancements, gaps in knowledge regarding the prognostic implications and underlying mechanisms of the GAA anomaly remain. This review aims to explore the implications of the GAA anomaly on cardiac mechanics and its impact on clinical outcomes in young patients after ASO. Advancements in imaging techniques, such as computational modeling, offer promising avenues to enhance our understanding of cardiac mechanics and improve clinical management.
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Affiliation(s)
- Valeria Pergola
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | - Elena Reffo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | | | | | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Raffaella Motta
- Radiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua.
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
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21
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Zhao X, Tan RS, Garg P, Chai P, Leng S, Bryant JA, Teo LLS, Yeo TJ, Fortier MV, Low TT, Ong CC, Zhang S, Van der Geest RJ, Allen JC, Tan TH, Yip JW, Tan JL, Hughes M, Plein S, Westenberg JJM, Zhong L. Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects. J Cardiovasc Magn Reson 2023; 25:50. [PMID: 37718441 PMCID: PMC10506211 DOI: 10.1186/s12968-023-00960-x] [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: 01/30/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Advances in four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) have allowed quantification of left ventricular (LV) and right ventricular (RV) blood flow. We aimed to (1) investigate age and sex differences of 4D flow CMR-derived LV and RV relative flow components and kinetic energy (KE) parameters indexed to end-diastolic volume (KEiEDV) in healthy subjects; and (2) assess the effects of age and sex on these parameters. METHODS We performed 4D flow analysis in 163 healthy participants (42% female; mean age 43 ± 13 years) of a prospective registry study (NCT03217240) who were free of cardiovascular diseases. Relative flow components (direct flow, retained inflow, delayed ejection flow, residual volume) and multiple phasic KEiEDV (global, peak systolic, average systolic, average diastolic, peak E-wave, peak A-wave) for both LV and RV were analysed. RESULTS Compared with men, women had lower median LV and RV residual volume, and LV peak and average systolic KEiEDV, and higher median values of RV direct flow, RV global KEiEDV, RV average diastolic KEiEDV, and RV peak E-wave KEiEDV. ANOVA analysis found there were no differences in flow components, peak and average systolic, average diastolic and global KEiEDV for both LV and RV across age groups. Peak A-wave KEiEDV increased significantly (r = 0.458 for LV and 0.341 for RV), whereas peak E-wave KEiEDV (r = - 0.355 for LV and - 0.318 for RV), and KEiEDV E/A ratio (r = - 0.475 for LV and - 0.504 for RV) decreased significantly, with age. CONCLUSION These data using state-of-the-art 4D flow CMR show that biventricular flow components and kinetic energy parameters vary significantly by age and sex. Age and sex trends should be considered in the interpretation of quantitative measures of biventricular flow. Clinical trial registration https://www. CLINICALTRIALS gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Ting Ting Low
- National University Hospital Singapore, Singapore, Singapore
| | - Ching Ching Ong
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J Van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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22
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Xu S, Wang F, Mai P, Peng Y, Shu X, Nie R, Zhang H. Mechanism Analysis of Vascular Calcification Based on Fluid Dynamics. Diagnostics (Basel) 2023; 13:2632. [PMID: 37627891 PMCID: PMC10453151 DOI: 10.3390/diagnostics13162632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Vascular calcification is the abnormal deposition of calcium phosphate complexes in blood vessels, which is regarded as the pathological basis of multiple cardiovascular diseases. The flowing blood exerts a frictional force called shear stress on the vascular wall. Blood vessels have different hydrodynamic properties due to discrepancies in geometric and mechanical properties. The disturbance of the blood flow in the bending area and the branch point of the arterial tree produces a shear stress lower than the physiological magnitude of the laminar shear stress, which can induce the occurrence of vascular calcification. Endothelial cells sense the fluid dynamics of blood and transmit electrical and chemical signals to the full-thickness of blood vessels. Through crosstalk with endothelial cells, smooth muscle cells trigger osteogenic transformation, involved in mediating vascular intima and media calcification. In addition, based on the detection of fluid dynamics parameters, emerging imaging technologies such as 4D Flow MRI and computational fluid dynamics have greatly improved the early diagnosis ability of cardiovascular diseases, showing extremely high clinical application prospects.
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Affiliation(s)
- Shuwan Xu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
| | - Feng Wang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
| | - Peibiao Mai
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
| | - Yanren Peng
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China; (Y.P.); (X.S.)
| | - Xiaorong Shu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China; (Y.P.); (X.S.)
| | - Ruqiong Nie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China; (Y.P.); (X.S.)
| | - Huanji Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
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23
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Maroun A, Quinn S, Dushfunian D, Weiss EK, Allen BD, Carr JC, Markl M. Clinical Applications of Four-Dimensional Flow MRI. Magn Reson Imaging Clin N Am 2023; 31:451-460. [PMID: 37414471 DOI: 10.1016/j.mric.2023.04.005] [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
Four-dimensional flow MRI is a powerful phase contrast technique used for assessing three-dimensional (3D) blood flow dynamics. By acquiring a time-resolved velocity field, it enables flexible retrospective analysis of blood flow that can include qualitative 3D visualization of complex flow patterns, comprehensive assessment of multiple vessels, reliable placement of analysis planes, and calculation of advanced hemodynamic parameters. This technique provides several advantages over routine two-dimensional flow imaging techniques, allowing it to become part of clinical practice at major academic medical centers. In this review, we present the current state-of-the-art cardiovascular, neurovascular, and abdominal applications.
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Affiliation(s)
- Anthony Maroun
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA.
| | - Sandra Quinn
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - David Dushfunian
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Elizabeth K Weiss
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
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24
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Panda A, Francois CJ, Bookwalter CA, Chaturvedi A, Collins JD, Leiner T, Rajiah PS. Non-Contrast Magnetic Resonance Angiography: Techniques, Principles, and Applications. Magn Reson Imaging Clin N Am 2023; 31:337-360. [PMID: 37414465 DOI: 10.1016/j.mric.2023.04.001] [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
Several non-contrast magnetic resonance angiography (MRA) techniques have been developed, providing an attractive alternative to contrast-enhanced MRA and a radiation-free alternative to computed tomography (CT) CT angiography. This review describes the physical principles, limitations, and clinical applications of bright-blood (BB) non-contrast MRA techniques. The principles of BB MRA techniques can be broadly divided into (a) flow-independent MRA, (b) blood-inflow-based MRA, (c) cardiac phase dependent, flow-based MRA, (d) velocity sensitive MRA, and (e) arterial spin-labeling MRA. The review also includes emerging multi-contrast MRA techniques that provide simultaneous BB and black-blood images for combined luminal and vessel wall evaluation.
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Affiliation(s)
- Ananya Panda
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | | | | | - Abhishek Chaturvedi
- Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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25
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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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26
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Lee YT, Chen SJ. Graph theory applications in congenital heart disease. Sci Rep 2023; 13:11135. [PMID: 37429950 DOI: 10.1038/s41598-023-38233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
Graph theory can be used to address problems with complex network structures. Congenital heart diseases (CHDs) involve complex abnormal connections between chambers, vessels, and organs. We proposed a new method to represent CHDs based on graph theory, wherein vertices were defined as the spaces through which blood flows and edges were defined by the blood flow between the spaces and direction of the blood flow. The CHDs of tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) were selected as examples for constructing directed graphs and binary adjacency matrices. Patients with totally repaired TOF, surgically corrected d-TGA, and Fontan circulation undergoing four-dimensional (4D) flow magnetic resonance imaging (MRI) were included as examples for constructing the weighted adjacency matrices. The directed graphs and binary adjacency matrices of the normal heart, extreme TOF undergoing a right modified Blalock-Taussig shunt, and d-TGA with a ventricular septal defect were constructed. The weighted adjacency matrix of totally repaired TOF was constructed using the peak velocities obtained from 4D flow MRI. The developed method is promising for representing CHDs and may be helpful in developing artificial intelligence and conducting future research on CHD.
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Affiliation(s)
- Yao-Ting Lee
- Department of Medical Imaging, National Taiwan University Hospital and Children Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Shyh-Jye Chen
- Department of Medical Imaging, National Taiwan University Hospital and Children Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
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27
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Punzo B, Ranieri B, Tramontano L, Affinito O, Franzese M, Bossone E, Saba L, Cavaliere C, Cademartiri F. 4D-Flow Cardiovascular Magnetic Resonance Sequence for Aortic Assessment: Multi-Vendor and Multi-Magnetic Field Reproducibility in Healthy Volunteers. J Clin Med 2023; 12:jcm12082960. [PMID: 37109295 PMCID: PMC10141060 DOI: 10.3390/jcm12082960] [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: 03/09/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES Four-dimensional (4D) flow cardiac magnetic resonance (CMR) represents an emerging technique for non-invasive evaluation of the aortic flow. The aim of this study was to investigate a 4D-flow CMR sequence for the assessment of thoracic aorta comparing different vendors and different magnetic fields of MR scanner in fifteen healthy volunteers. METHODS CMR was performed on three different MRI scanners: one at 1.5 T and two at 3 T. Flow parameters and planar wall shear stress (WSS) were extracted from six transversal planes along the full thoracic aorta by three operators. Inter-vendor comparability as well as scan-rescan, intra- and interobserver reproducibility were examined. RESULTS A high heterogeneity was found in the comparisons for each operator and for each scanner in the six transversal planes analysis (Friedman rank-sum test; p-value ≤ 0.05). Among all, the most reproducible measures were extracted for the sinotubular junction plane and for the flow parameters. CONCLUSIONS Our results suggest that standardized procedures have to be defined to make more comparable and reproducible 4D-flow parameters and mainly, clinical impactfulness. Further studies on sequences development are needed to validate 4D-flow MRI assessment across vendors and magnetic fields also compared to a missing gold standard.
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Affiliation(s)
- Bruna Punzo
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - Brigida Ranieri
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | | | - Ornella Affinito
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - Monica Franzese
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - Eduardo Bossone
- Department of Public Health, "Federico II" University of Naples, 80131 Naples, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari, 09123 Cagliari, Italy
| | - Carlo Cavaliere
- IRCCS SYNLAB SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
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28
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Estimation of venous sinus pressure drop in patients with idiopathic intracranial hypertension using 4D-flow MRI. Eur Radiol 2023; 33:2576-2584. [PMID: 36287270 DOI: 10.1007/s00330-022-09199-z] [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: 05/01/2022] [Revised: 07/28/2022] [Accepted: 09/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We aimed to explore a non-invasive estimate of pressure drop in patients who undergo venous sinus stenting to treat idiopathic intracranial hypertension (IIH). METHODS This prospective study included 28 IIH patients scheduled for venous stenting. 4D-flow MRI was acquired 24-48 h before venous manometry. Manometry-obtained pressure drop (Mp) was dichotomized into low (Lp: 0-8 mmHg) and high (Hp: 8-30 mmHg) groups. Hemodynamic indices were compared between Lp and Hp. Trans-stenotic pressure drop was estimated by work-energy equation, simplified Bernoulli equation, vorticity magnitude, and velocity difference between inlet and outlet and was compared with Mp. Measurement agreement, correlation, and accuracy were evaluated using the κ coefficient, Pearson's r, and confusion matrix-derived accuracy. RESULTS Among 28 patients (mean age 38.8 ± 12.7), 19 (67.9%) were female. Work-energy equation-estimated pressure drop (WEp) had strong correlation (r = 0.91, 95% confidence interval [CI]: 0.81-0.96, p < 0.001) and high agreement (intraclass correlation coefficient = 0.90, 95% CI: 0.78-0.95, p < 0.001) with Mp. WEp classified Lp and Hp with an accuracy of 0.96. The κ value between WEp and Mp was 0.92 (95% CI: 0.78-1.00). In the work-energy equation, the viscosity energy term (Ve) had the largest weights, and the ratio of Ve to the summation of the three energy terms was 0.93 ± 0.07. Ve had strong correlation with mVort (r = 0.93, 95% CI: 0.85-0.97, p < 0.001), and mean vorticity magnitude was significantly elevated in Hp compared to that in Lp (259.8 vs. 174.9 mL/s, p < 0.001). CONCLUSION Trans-stenotic pressure drop in IIH can be estimated using the work-energy equation with favorable accuracy. KEY POINTS • Trans-stenotic pressure drop in patients with idiopathic intracranial hypertension can be estimated accurately with the work-energy equation using the 4D-flow MRI full velocity field. • Compared with traditional venous sinus manometry, the 4D-flow MRI-derived pressure drop is totally non-invasive and cost-saving. • 4D-flow MRI may help neurointerventionalist to select IIH patients suitable for venous sinus stenting.
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Mutlu O, Salman HE, Al-Thani H, El-Menyar A, Qidwai UA, Yalcin HC. How does hemodynamics affect rupture tissue mechanics in abdominal aortic aneurysm: Focus on wall shear stress derived parameters, time-averaged wall shear stress, oscillatory shear index, endothelial cell activation potential, and relative residence time. Comput Biol Med 2023; 154:106609. [PMID: 36724610 DOI: 10.1016/j.compbiomed.2023.106609] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/24/2023]
Abstract
An abdominal aortic aneurysm (AAA) is a critical health condition with a risk of rupture, where the diameter of the aorta enlarges more than 50% of its normal diameter. The incidence rate of AAA has increased worldwide. Currently, about three out of every 100,000 people have aortic diseases. The diameter and geometry of AAAs influence the hemodynamic forces exerted on the arterial wall. Therefore, a reliable assessment of hemodynamics is crucial for predicting the rupture risk. Wall shear stress (WSS) is an important metric to define the level of the frictional force on the AAA wall. Excessive levels of WSS deteriorate the remodeling mechanism of the arteries and lead to abnormal conditions. At this point, WSS-related hemodynamic parameters, such as time-averaged WSS (TAWSS), oscillatory shear index (OSI), endothelial cell activation potential (ECAP), and relative residence time (RRT) provide important information to evaluate the shear environment on the AAA wall in detail. Calculation of these parameters is not straightforward and requires a physical understanding of what they represent. In addition, computational fluid dynamics (CFD) solvers do not readily calculate these parameters when hemodynamics is simulated. This review aims to explain the WSS-derived parameters focusing on how these represent different characteristics of disturbed hemodynamics. A representative case is presented for spatial and temporal formulation that would be useful for interested researchers for practical calculations. Finally, recent hemodynamics investigations relating WSS-related parameters with AAA rupture risk assessment are presented. This review will be useful to understand the physical representation of WSS-related parameters in cardiovascular flows and how they can be calculated practically for AAA investigations.
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Affiliation(s)
- Onur Mutlu
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Huseyin Enes Salman
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Uvais Ahmed Qidwai
- Department of Computer Science Engineering, Qatar University, Doha, Qatar
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Moradi H, Al-Hourani A, Concilia G, Khoshmanesh F, Nezami FR, Needham S, Baratchi S, Khoshmanesh K. Recent developments in modeling, imaging, and monitoring of cardiovascular diseases using machine learning. Biophys Rev 2023; 15:19-33. [PMID: 36909958 PMCID: PMC9995635 DOI: 10.1007/s12551-022-01040-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular diseases are the leading cause of mortality, morbidity, and hospitalization around the world. Recent technological advances have facilitated analyzing, visualizing, and monitoring cardiovascular diseases using emerging computational fluid dynamics, blood flow imaging, and wearable sensing technologies. Yet, computational cost, limited spatiotemporal resolution, and obstacles for thorough data analysis have hindered the utility of such techniques to curb cardiovascular diseases. We herein discuss how leveraging machine learning techniques, and in particular deep learning methods, could overcome these limitations and offer promise for translation. We discuss the remarkable capacity of recently developed machine learning techniques to accelerate flow modeling, enhance the resolution while reduce the noise and scanning time of current blood flow imaging techniques, and accurate detection of cardiovascular diseases using a plethora of data collected by wearable sensors.
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Affiliation(s)
- Hamed Moradi
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Akram Al-Hourani
- School of Engineering, RMIT University, Melbourne, Victoria Australia
| | | | - Farnaz Khoshmanesh
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Victoria Australia
| | - Farhad R. Nezami
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Scott Needham
- Leading Technology Group, Melbourne, Victoria Australia
| | - Sara Baratchi
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria Australia
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Berczeli M, Chinnadurai P, Legeza P, Peden EK, Bavare CS, Chang SM, Lumsden AB. Dynamic, Time-Resolved CT Angiography After EVAR: A Quantitative Approach to Accurately Characterize Aortic Endoleak Type and Identify Inflow Vessels. J Endovasc Ther 2023; 30:123-131. [PMID: 35068202 DOI: 10.1177/15266028211070970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Our purpose was to study the accuracy of dynamic computed tomography angiography (d-CTA) in characterizing endoleak type, inflow vessels as compared with digital subtraction angiography (DSA) using qualitative and quantitative analysis. METHODS Between March 2019 and January 2021, all patients who underwent d-CTA imaging after EVAR were retrospectively reviewed. Two blinded independent reviewers qualitatively reviewed d-CTA and DSA images. Quantitative region of interest (ROI) analysis was performed by measuring time-resolved contrast enhancement within the aorta and endoleak lesion(s) in the aneurysm sac. Differences between time-to-peak enhancement (Δ TTP) across different ROIs were quantified. RESULTS A total of 48 patients underwent d-CTA during the study period, of whom 24 patients had abdominal EVAR and DSA imaging for comparison. Qualitative review of DSA imaging showed type I (n=4), type II (n=16), and type III (n=2) and no endoleak (n=2). In 23 of 24 patients (95.8%), d-CTA findings correlated with DSA findings for endoleak type. One patient had a type III endoleak that was demonstrated only in d-CTA (arising from defect in polymer sealing ring of Ovation stent graft) imaging. In type II endoleak cases, d-CTA identified more inflow vessels than DSA imaging (33 vs 21 vessels, p=0.010). Quantitative analysis showed mean (±SD) Δ TTP values for type I endoleak as 1.8 (±1.8) seconds, type II as 9.6 (±3.5) seconds, and for type III endoleak as 5.6 (±1.3) seconds. CONCLUSION Dynamic CTA can accurately characterize aortic endoleak type, inflow vessels as compared with DSA imaging. Quantitative parameters such as Δ TTP enhancement can help better differentiate endoleak types and provide an objective approach to endoleak diagnosis.
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Affiliation(s)
- Marton Berczeli
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Ponraj Chinnadurai
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.,Advanced Therapies, Siemens Medical Solutions USA Inc, Malvern, PA, USA
| | - Peter Legeza
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Eric K Peden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Charudatta S Bavare
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Su Min Chang
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Alan B Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
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32
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Counseller Q, Aboelkassem Y. Recent technologies in cardiac imaging. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:984492. [PMID: 36704232 PMCID: PMC9872125 DOI: 10.3389/fmedt.2022.984492] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiac imaging allows physicians to view the structure and function of the heart to detect various heart abnormalities, ranging from inefficiencies in contraction, regulation of volumetric input and output of blood, deficits in valve function and structure, accumulation of plaque in arteries, and more. Commonly used cardiovascular imaging techniques include x-ray, computed tomography (CT), magnetic resonance imaging (MRI), echocardiogram, and positron emission tomography (PET)/single-photon emission computed tomography (SPECT). More recently, even more tools are at our disposal for investigating the heart's physiology, performance, structure, and function due to technological advancements. This review study summarizes cardiac imaging techniques with a particular interest in MRI and CT, noting each tool's origin, benefits, downfalls, clinical application, and advancement of cardiac imaging in the near future.
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Affiliation(s)
- Quinn Counseller
- College of Health Sciences, University of Michigan, Flint, MI, United States
| | - Yasser Aboelkassem
- College of Innovation and Technology, University of Michigan, Flint, MI, United States,Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States,Correspondence: Yasser Aboelkassem
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Qin JJ, Obeidy P, Gok M, Gholipour A, Grieve SM. 4D-flow MRI derived wall shear stress for the risk stratification of bicuspid aortic valve aortopathy: A systematic review. Front Cardiovasc Med 2023; 9:1075833. [PMID: 36698944 PMCID: PMC9869052 DOI: 10.3389/fcvm.2022.1075833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose Current intervention guidelines for bicuspid aortic valve (BAV) associated ascending aorta (AAo) dilatation are suboptimal predictors of clinical outcome. There is growing interest in identifying better biomarkers such as wall shear stress (WSS) to help risk stratify BAV aortopathy. The aim of the systematic review is to synthesize existing evidence of the relationship between WSS and aortopathy in the BAV population. Methods A comprehensive literature search of available major databases was performed in May 2022 to include studies that used four-dimensional flow cardiac magnetic resonance (4D-flow) MRI to quantify WSS in the AAo in adult BAV populations. Summary results and statistical analysis were provided for key numerical results. A narrative summary was provided to assess similarities between studies. Results A total of 26 studies that satisfied selection criteria and quality assessment were included in the review. The presence of BAV resulted in significantly elevated WSS magnitude and circumferential WSS, but not axial WSS. The presence of aortic stenosis had additional impact on WSS and flow alterations. BAV phenotypes were associated with different WSS distributions and flow profiles. Altered protein expression in the AAo wall associated with WSS supported the contribution of altered hemodynamics to aortopathy in addition to genetic factors. Conclusion WSS has the potential to be a valid biomarker for BAV aortopathy. Future work would benefit from larger study cohorts with longitudinal evaluations to further characterize WSS association with aortopathy, mortality, and morbidities. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337077, identifier CRD42022337077.
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Affiliation(s)
- Jiaxing Jason Qin
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Peyman Obeidy
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mustafa Gok
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Alireza Gholipour
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia,Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,*Correspondence: Stuart M. Grieve,
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Montalt-Tordera J, Steeden JA, Muthurangu V. Editorial for "Automatic Time-Resolved Cardiovascular Segmentation of 4D Flow MRI Using Deep Learning". J Magn Reson Imaging 2023; 57:204-205. [PMID: 35510802 DOI: 10.1002/jmri.28220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Jennifer A Steeden
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, University College London, London, UK
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Zhao X, Leng S, Tan RS, Chai P, Yeo TJ, Bryant JA, Teo LLS, Fortier MV, Ruan W, Low TT, Ong CC, Zhang S, van der Geest RJ, Allen JC, Hughes M, Garg P, Tan TH, Yip JW, Tan JL, Zhong L. Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension. J Cardiovasc Magn Reson 2022; 24:61. [PMID: 36451198 PMCID: PMC9714144 DOI: 10.1186/s12968-022-00896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 10/19/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) offers comprehensive right ventricular (RV) evaluation in pulmonary arterial hypertension (PAH). Emerging four-dimensional (4D) flow CMR allows visualization and quantification of intracardiac flow components and calculation of phasic blood kinetic energy (KE) parameters but it is unknown whether these parameters are associated with cardiopulmonary exercise test (CPET)-assessed exercise capacity, which is a surrogate measure of survival in PAH. We compared 4D flow CMR parameters in PAH with healthy controls, and investigated the association of these parameters with RV remodelling, RV functional and CPET outcomes. METHODS PAH patients and healthy controls from two centers were prospectively enrolled to undergo on-site cine and 4D flow CMR, and CPET within one week. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes (EDV). Phasic (peak systolic, average systolic, and peak E-wave) LV and RV blood flow KE indexed to EDV (KEIEDV) and ventricular LV and RV flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) were calculated. Oxygen uptake (VO2), carbon dioxide production (VCO2) and minute ventilation (VE) were measured and recorded. RESULTS 45 PAH patients (46 ± 11 years; 7 M) and 51 healthy subjects (46 ± 14 years; 17 M) with no significant differences in age and gender were analyzed. Compared with healthy controls, PAH had significantly lower median RV direct flow, RV delayed ejection flow, RV peak E-wave KEIEDV, peak VO2, and percentage (%) predicted peak VO2, while significantly higher median RV residual volume and VE/VCO2 slope. RV direct flow and RV residual volume were significantly associated with RV remodelling, function, peak VO2, % predicted peak VO2 and VE/VCO2 slope (all P < 0.01). Multiple linear regression analyses showed RV direct flow to be an independent marker of RV function, remodelling and exercise capacity. CONCLUSION In this 4D flow CMR and CPET study, RV direct flow provided incremental value over RVEF for discriminating adverse RV remodelling, impaired exercise capacity, and PAH with intermediate and high risk based on risk score. These data suggest that CMR with 4D flow CMR can provide comprehensive assessment of PAH severity, and may be used to monitor disease progression and therapeutic response. TRIAL REGISTRATION NUMBER https://www. CLINICALTRIALS gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
| | - Shuang Leng
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Wen Ruan
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
| | - Ting Ting Low
- National University Hospital Singapore, Singapore, Singapore
| | - Ching Ching Ong
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Dong ML, Azarine A, Haddad F, Amsallem M, Kim YW, Yang W, Fadel E, Aubrege L, Loecher M, Ennis D, Pavec JL, Vignon-Clementel I, Feinstein JA, Mercier O, Marsden AL. 4D flow cardiovascular magnetic resonance recovery profiles following pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension. J Cardiovasc Magn Reson 2022; 24:59. [PMID: 36372884 PMCID: PMC9661778 DOI: 10.1186/s12968-022-00893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) allows comprehensive assessment of pulmonary artery (PA) flow dynamics. Few studies have characterized longitudinal changes in pulmonary flow dynamics and right ventricular (RV) recovery following a pulmonary endarterectomy (PEA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This can provide novel insights of RV and PA dynamics during recovery. We investigated the longitudinal trajectory of 4D flow metrics following a PEA including velocity, vorticity, helicity, and PA vessel wall stiffness. METHODS Twenty patients with CTEPH underwent pre-PEA and > 6 months post-PEA CMR imaging including 4D flow CMR; right heart catheter measurements were performed in 18 of these patients. We developed a semi-automated pipeline to extract integrated 4D flow-derived main, left, and right PA (MPA, LPA, RPA) volumes, velocity flow profiles, and secondary flow profiles. We focused on secondary flow metrics of vorticity, volume fraction of positive helicity (clockwise rotation), and the helical flow index (HFI) that measures helicity intensity. RESULTS Mean PA pressures (mPAP), total pulmonary resistance (TPR), and normalized RV end-systolic volume (RVESV) decreased significantly post-PEA (P < 0.002). 4D flow-derived PA volumes decreased (P < 0.001) and stiffness, velocity, and vorticity increased (P < 0.01) post-PEA. Longitudinal improvements from pre- to post-PEA in mPAP were associated with longitudinal decreases in MPA area (r = 0.68, P = 0.002). Longitudinal improvements in TPR were associated with longitudinal increases in the maximum RPA HFI (r=-0.85, P < 0.001). Longitudinal improvements in RVESV were associated with longitudinal decreases in MPA fraction of positive helicity (r = 0.75, P = 0.003) and minimum MPA HFI (r=-0.72, P = 0.005). CONCLUSION We developed a semi-automated pipeline for analyzing 4D flow metrics of vessel stiffness and flow profiles. PEA was associated with changes in 4D flow metrics of PA flow profiles and vessel stiffness. Longitudinal analysis revealed that PA helicity was associated with pulmonary remodeling and RV reverse remodeling following a PEA.
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Affiliation(s)
- Melody L Dong
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Arshid Azarine
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Young-Wouk Kim
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Weiguang Yang
- Department of Pediatric Cardiology, Stanford University, Stanford, CA, USA
| | - Elie Fadel
- Biomedical Engineering Lab, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Université Paris-Saclay, Le Plessis Robinson, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | - Laure Aubrege
- Biomedical Engineering Lab, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Daniel Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Jérôme Le Pavec
- Department of Respirology, Marie Lannelongue Hospital, Le Plessis Robinson, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | | | | | - Olaf Mercier
- Biomedical Engineering Lab, Groupe Hospitalier Paris Saint-Joseph, Paris, France
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Université Paris-Saclay, Le Plessis Robinson, France
- Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, INSERM UMR-S 999, Le Plessis Robinson, France
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Department of Pediatric Cardiology, Stanford University, Stanford, CA, USA.
- Department of Bioengineering and Pediatric Cardiology, Stanford University, Stanford, CA, USA.
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Polacin M, Geiger J, Burkhardt B, Callaghan FM, Valsangiacomo E, Kellenberger C. Quantitative evaluation of aortic valve regurgitation in 4D flow cardiac magnetic resonance: at which level should we measure? BMC Med Imaging 2022; 22:169. [PMID: 36167535 PMCID: PMC9513957 DOI: 10.1186/s12880-022-00895-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To find the best level to measure aortic flow for quantification of aortic regurgitation (AR) in 4D flow CMR. METHODS In 27 congenital heart disease patients with AR (67% male, 31 ± 16 years) two blinded observers measured antegrade, retrograde, net aortic flow volumes and regurgitant fractions at 6 levels in 4D flow: (1) below the aortic valve (AV), (2) at the AV, (3) at the aortic sinus, (4) at the sinotubular junction, (5) at the level of the pulmonary arteries (PA) and (6) below the brachiocephalic trunk. 2D phase contrast (2DPC) sequences were acquired at the level of PA. All patients received prior transthoracic echocardiography (TTE) with AR severity grading according to a recommended multiparametric approach. RESULTS After assigning 2DPC measurements into AR grading, agreement between TTE AR grading and 2DPC was good (κ = 0.88). In 4D flow, antegrade flow was similar between the six levels (p = 0.87). Net flow was higher at level 1-2 than at levels 3-6 (p < 0.05). Retrograde flow and regurgitant fraction at level 1-2 were lower compared to levels 3-6 (p < 0.05). Reproducibility (inter-reader agreement: ICC 0.993, 95% CI 0.986-0.99; intra-reader agreement: ICC 0.982, 95%CI 0.943-0.994) as well as measurement agreement between 4D flow and 2DPC (ICC 0.994; 95%CI 0.989 - 0.998) was best at the level of PA. CONCLUSION For estimating severity of AR in 4D flow, best reproducibility along with best agreement with 2DPC measurements can be expected at the level of PA. Measurements at AV or below AV might underestimate AR.
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Affiliation(s)
- Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Department of Diagnostic Imaging, University Children`s Hospital, University of Zurich, Zurich, Switzerland.
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children`s Hospital, University of Zurich, Zurich, Switzerland
| | - Barbara Burkhardt
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children`s Hospital, University of Zurich, Zurich, Switzerland
| | - Fraser M Callaghan
- Center for MR Research, University Children's Hospital, University of Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Emanuela Valsangiacomo
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children`s Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Kellenberger
- Department of Diagnostic Imaging, University Children`s Hospital, University of Zurich, Zurich, Switzerland
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Abe R, Saji M, Izumi Y, Takamisawa I, Kishiki K, Maekawara S, Nagatomo Y, Yazaki S, Nanasato M, Isobe M. Usefulness of a Pulse Oximeter and Multimodality Imaging for Diagnosing Platypnea-orthodeoxia Syndrome. Intern Med 2022; 62:1305-1309. [PMID: 36104196 DOI: 10.2169/internalmedicine.0159-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Platypnea-orthodeoxia syndrome (POS) is a rare disease characterized by dyspnea and hypoxemia in orthostatism that improves in the recumbent position. We herein report an 81-year-old woman with dyspnea in the upright position following thoracic vertebral compression fractures. After the patient's daughter brought a recording showing decreasing SpO2 (peripheral capillary oxygen saturation) in the upright position as measured by a portable pulse oximeter outside the hospital, a small atrial septal defect (ASD) was detected. A contrast echocardiogram and four-dimensional flow magnetic resonance imaging demonstrated a right-to-left shunt. The patient's symptoms dramatically improved after percutaneous ASD closure. In conclusion, such new technologies are useful for diagnosing POS.
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Affiliation(s)
- Ryo Abe
- Department of Cardiology, Sakakibara Heart Institute, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Japan
- Department of Adult Congenital Heart Disease Center, Sakakibara Heart Institute, Japan
| | - Yuki Izumi
- Department of Cardiology, Sakakibara Heart Institute, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Japan
- Department of Adult Congenital Heart Disease Center, Sakakibara Heart Institute, Japan
| | - Kanako Kishiki
- Department of Adult Congenital Heart Disease Center, Sakakibara Heart Institute, Japan
- Department of Pediatric Cardiology, Sakakibara Heart Institute, Japan
| | - Satonori Maekawara
- Department of Cardiology, Sakakibara Heart Institute, Japan
- Department of Cardiology, National Defense Medical College Hospital, Japan
| | - Yuji Nagatomo
- Department of Cardiology, Sakakibara Heart Institute, Japan
- Department of Cardiology, National Defense Medical College Hospital, Japan
| | - Satoshi Yazaki
- Department of Adult Congenital Heart Disease Center, Sakakibara Heart Institute, Japan
- Department of Pediatric Cardiology, Sakakibara Heart Institute, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Japan
- Department of Adult Congenital Heart Disease Center, Sakakibara Heart Institute, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Japan
- Department of Adult Congenital Heart Disease Center, Sakakibara Heart Institute, Japan
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Evaluation of Left Ventricular Function Using Four-Dimensional Flow Cardiovascular Magnetic Resonance: A Systematic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9090304. [PMID: 36135449 PMCID: PMC9503592 DOI: 10.3390/jcdd9090304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
There is increasing recognition of the value of four-dimensional flow cardiovascular magnetic resonance (4D-flow MRI) as a potential means to detect and measure abnormal flow behaviour that occurs during early left ventricular (LV) dysfunction. We performed a systematic review of current literature on the role of 4D-flow MRI-derived flow parameters in quantification of LV function with a focus on potential clinical applicability. A comprehensive literature search was performed in March 2022 on available databases. A total of 1186 articles were identified, and 30 articles were included in the final analysis. All the included studies were ranked as “highly clinically applicable”. There was considerable variability in the reporting of methodologies and analyses. All the studies were small-scale feasibility or pilot studies investigating a diverse range of flow parameters. The most common primary topics of investigation were energy-related flow parameters, flow components and vortex analysis which demonstrated potentials for quantifying early diastolic dysfunction, whilst other parameters including haemodynamic forces, residence time distribution and turbulent kinetic energy remain in need of further evaluation. Systematic quantitative comparison of study findings was not possible due to this heterogeneity, therefore limiting the collective power of the studies in evaluating clinical applicability of the flow parameters. To achieve broader clinical application of 4D-flow MRI, larger scale investigations are required, together with standardisation of methodologies and analytical approach.
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Sarabian M, Babaee H, Laksari K. Physics-Informed Neural Networks for Brain Hemodynamic Predictions Using Medical Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:2285-2303. [PMID: 35320090 PMCID: PMC9437127 DOI: 10.1109/tmi.2022.3161653] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Determining brain hemodynamics plays a critical role in the diagnosis and treatment of various cerebrovascular diseases. In this work, we put forth a physics-informed deep learning framework that augments sparse clinical measurements with one-dimensional (1D) reduced-order model (ROM) simulations to generate physically consistent brain hemodynamic parameters with high spatiotemporal resolution. Transcranial Doppler (TCD) ultrasound is one of the most common techniques in the current clinical workflow that enables noninvasive and instantaneous evaluation of blood flow velocity within the cerebral arteries. However, it is spatially limited to only a handful of locations across the cerebrovasculature due to the constrained accessibility through the skull's acoustic windows. Our deep learning framework uses in vivo real-time TCD velocity measurements at several locations in the brain combined with baseline vessel cross-sectional areas acquired from 3D angiography images and provides high-resolution maps of velocity, area, and pressure in the entire brain vasculature. We validate the predictions of our model against in vivo velocity measurements obtained via four-dimensional (4D) flow magnetic resonance imaging (MRI) scans. We then showcase the clinical significance of this technique in diagnosing cerebral vasospasm (CVS) by successfully predicting the changes in vasospastic local vessel diameters based on corresponding sparse velocity measurements. We show this capability by generating synthetic blood flow data after cerebral vasospasm at various levels of stenosis. Here, we demonstrate that the physics-based deep learning approach can estimate and quantify the subject-specific cerebral hemodynamic variables with high accuracy despite lacking knowledge of inlet and outlet boundary conditions, which is a significant limitation for the accuracy of the conventional purely physics-based computational models.
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Echocardiographic Quantification of Superior Vena Cava (SVC) Flow in Neonates: Pilot Study of Modified Technique. Diagnostics (Basel) 2022; 12:diagnostics12092083. [PMID: 36140485 PMCID: PMC9498289 DOI: 10.3390/diagnostics12092083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Ultrasound Superior Vena Cava (SVC) flow assessment is a common measure of systemic and cerebral perfusion, although accuracy is limited. The aim of this study was to evaluate whether any improvements in accuracy could be achieved by measuring stroke distance from the instantaneous mean velocity, rather than from peak velocity, and by directly tracing area from images obtained with a high frequency linear probe. Paired phase contrast magnetic resonance imaging (PCMRI) and ultrasound assessments of SVC flow were performed in a pilot cohort of 7 infants. Median postnatal age, corrected gestation and weight at scan were 7 (2–74) days, 34.8 (31.7–37.2) weeks 1870 (970–2660) g. Median interval between PCMRI and ultrasound scans was 0.3 (0.2–0.5) h. The methodology trialed here showed a better agreement with PCMRI (mean bias −8 mL/kg/min, LOA −25–+8 mL/kg/min), compared to both the original method reported by Kluckow et al. (mean bias + 42 mL/kg/min, LOA −53–+137 mL/kg/min), and our own prior adaptation (mean bias + 23 mL/kg/min, LOA −25–+71 mL/kg/min). Ultrasound assessment of SVC flow volume using the modifications described led to enhanced accuracy and decreased variability compared to prior techniques in a small cohort of premature infants.
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Gorecka M, Bissell MM, Higgins DM, Garg P, Plein S, Greenwood JP. Rationale and clinical applications of 4D flow cardiovascular magnetic resonance in assessment of valvular heart disease: a comprehensive review. J Cardiovasc Magn Reson 2022; 24:49. [PMID: 35989320 PMCID: PMC9394062 DOI: 10.1186/s12968-022-00882-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Accurate evaluation of valvular pathology is crucial in the timing of surgical intervention. Whilst transthoracic echocardiography is widely available and routinely used in the assessment of valvular heart disease, it is bound by several limitations. Although cardiovascular magnetic resonance (CMR) imaging can overcome many of the challenges encountered by echocardiography, it also has a number of limitations. MAIN TEXT 4D Flow CMR is a novel technique, which allows time-resolved, 3-dimensional imaging. It enables visualisation and direct quantification of flow and peak velocities of all valves simultaneously in one simple acquisition, without any geometric assumptions. It also has the unique ability to measure advanced haemodynamic parameters such as turbulent kinetic energy, viscous energy loss rate and wall shear stress, which may add further diagnostic and prognostic information. Although 4D Flow CMR acquisition can take 5-10 min, emerging acceleration techniques can significantly reduce scan times, making 4D Flow CMR applicable in contemporary clinical practice. CONCLUSION 4D Flow CMR is an emerging CMR technique, which has the potential to become the new reference-standard method for the evaluation of valvular lesions. In this review, we describe the clinical applications, advantages and disadvantages of 4D Flow CMR in the assessment of valvular heart disease.
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Affiliation(s)
- Miroslawa Gorecka
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Malenka M Bissell
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
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Kreimer F, Gotzmann M. Left Atrial Cardiomyopathy - A Challenging Diagnosis. Front Cardiovasc Med 2022; 9:942385. [PMID: 35845077 PMCID: PMC9280085 DOI: 10.3389/fcvm.2022.942385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/14/2022] [Indexed: 01/08/2023] Open
Abstract
Left atrial cardiomyopathy (LACM) has been an ongoing focus of research for several years. There is evidence that LACM is responsible for atrial fibrillation and embolic strokes of undetermined sources. Therefore, the correct diagnosis of LACM is of clinical importance. Various techniques, including electrocardiography, echocardiography, cardiac magnetic resonance imaging, computed tomography, electroanatomic mapping, genetic testing, and biomarkers, can both identify and quantify structural, mechanical as well as electrical dysfunction in the atria. However, the question arises whether these techniques can reliably diagnose LACM. Because of its heterogeneity, clinical diagnosis is challenging. To date, there are no recommendations for standardized diagnosis of suspected LACM. However, standardization could help to classify LACM more precisely and derive therapeutic directions to improve individual patient management. In addition, uniform diagnostic criteria for LACM could be important for future studies. Combining several parameters and relating them seems beneficial to approach the diagnosis of LACM. This review provides an overview of the current evidence regarding the diagnosis of LACM, in which several potential parameters are discussed and, consequently, a proposal for a diagnostic algorithm is presented.
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Affiliation(s)
- Fabienne Kreimer
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Bochum, Germany
| | - Michael Gotzmann
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr University Bochum, Bochum, Germany
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Compact pediatric cardiac magnetic resonance imaging protocols. Pediatr Radiol 2022:10.1007/s00247-022-05447-y. [PMID: 35821442 DOI: 10.1007/s00247-022-05447-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
Cardiac MRI is in many respects an ideal modality for pediatric cardiovascular imaging, enabling a complete noninvasive assessment of anatomy, morphology, function and flow in one radiation-free and potentially non-contrast exam. Nonetheless, traditionally lengthy and complex imaging acquisition strategies have often limited its broader use beyond specialized centers. In this review, the author presents practical cardiac MRI imaging protocols to facilitate the performance of succinct yet successful exams that provide the most salient clinical data for the majority of congenital and acquired pediatric cardiac disease. In addition, the author reviews newer and evolving techniques that permit more rapid but similarly diagnostic MRI, including compressed sensing and artificial intelligence/machine learning reconstruction, four-dimensional flow acquisition and blood pool contrast agents. With the modern armamentarium of cardiac MRI methods, the goal of compact yet comprehensive exams in children can now be realized.
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Comparison of ultrasound vector flow imaging and CFD simulations with PIV measurements of flow in a left ventricular outflow trackt phantom - Implications for clinical use and in silico studies. Comput Biol Med 2022; 146:105358. [DOI: 10.1016/j.compbiomed.2022.105358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 11/21/2022]
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Xu W, Sun X, Tao X, Wang D, Zhen Y, Liu X, An J, Xie W, Liu M. Characteristics of Right Ventricular Blood Flow in Patients With Chronic Thromboembolic Pulmonary Hypertension: An Analysis With 4-Dimensional Flow Cardiovascular Magnetic Resonance Imaging. Front Cardiovasc Med 2022; 9:900301. [PMID: 35783864 PMCID: PMC9240307 DOI: 10.3389/fcvm.2022.900301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBlood flow is closely related to function, but currently, the relationship of right ventricular (RV) blood flow components with RV function and hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. Our objective is to qualify RV function with 4-dimensional flow cardiovascular magnetic resonance (4D-Flow CMR) imaging and to investigate the correlation between RV flow and hemodynamics in patients with CTEPH.MethodsRetrospective enrollment included 67 patients with CTEPH (mean age 47.8±14.2 years, 47 men) who underwent CMR and right heart catheterization (RHC) within 2 days. RHC was used to evaluate hemodynamics. RV flow components including the percentages of direct flow (PDF), retained inflow (PRI), delayed ejection flow (PDEF), and residual volume (PRVo) were quantified on 4D-Flow sequence. RV functional metrics were determined with the CINE balanced steady-state free precession sequence. The sum of PDF and PDEF was compared with RV eject fraction (RVEF). The correlation among RV flow components, RV functional metrics and hemodynamics was analyzed with spearman correlation analysis.ResultsThe median (interquartile range) of RVEF, PDF, PDEF, PRI, and PRVo, respectively was 35.5% (18.2, 45.6%), 18% (8.4, 21.4%), 15.1% (13.5, 19.0%), 15.9% (13.8, 20.8%), and 50.6% (35.6, 60.4%). The sum of PDF and PDEF is 35.1% (24.8, 46.6%), which was similar to RVEF (z = 0.58, p = 0.561). PDF negatively correlated with right ventricular end-systolic volume index (RVESVI), right ventricular myocardial mass index (RVMI) and right ventricular global longitudinal strain (r = −0.61, −0.65, −0.64, p < 0.001). PRVo positively correlated with RVESVI and RVMI (r = 0.50, 0.58, p < 0.001). PDF negatively correlated with pulmonary vascular resistance (PVR) (r = −0.72, p < 0.001) while it positively correlated with cardiac output (CO) and cardiac index (CI) (r = 0.64 & 0.52, p < 0.001). PRVo positively correlated with mean pulmonary pressure and PVR (r = 0.57&0.54, p < 0.001). Total five patients died in the perioperative period. RVEF in the deceased patients was similar to survivors (z = −1.163, p = 0.092). In comparison with the survivors, RVPDF in the deceased patients significantly reduced (z = −2.158, p = 0.029) while RVPDEF, RVPRI, and RVPRVo in deceased patients were similar to survivors.Conclusion4D-Flow CMR can provide simultaneous quantification of RV function and hemodynamics in the assessment of CTEPH without breath-holding. The reduced PDF and increased PRVo were the main characteristics of RV flow in CTEPH.
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Affiliation(s)
- Wenqing Xu
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xuebiao Sun
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xincao Tao
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Dingyi Wang
- China-Japan Friendship Hospital, Institute of Clinical Medical Sciences, Beijing, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shanghai, China
| | - Wanmu Xie
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Min Liu
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Azarine A, Scalbert F, Garçon P. Cardiac functional imaging. Presse Med 2022; 51:104119. [PMID: 35321846 DOI: 10.1016/j.lpm.2022.104119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.
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Affiliation(s)
- Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - François Scalbert
- Nuclear Medecine Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France
| | - Philippe Garçon
- Cardiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
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Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT working group of the Italian Society of Pediatric Cardiology (SICP) and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) Part I. Radiol Med 2022; 127:788-802. [PMID: 35608758 PMCID: PMC9308607 DOI: 10.1007/s11547-022-01490-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. Nevertheless, correct execution and interpretation require in-depth knowledge of all technical and clinical aspects of CHD, a careful assessment of risks and benefits before each exam, proper imaging protocols to maximize diagnostic information, minimizing harm. This position paper, written by experts from the Working Group of the Italian Society of Pediatric Cardiology and from the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, is intended as a practical guide for applying CCT and CMR in children and adults with CHD, wishing to support Radiologists, Pediatricians, Cardiologists and Cardiac Surgeons in the multimodality diagnostic approach to these patients. The first part provides a review of the most relevant literature in the field, describes each modality's advantage and drawback, making considerations on the main applications, image quality, and safety issues. The second part focuses on clinical indications and appropriateness criteria for CMR and CCT, considering the level of CHD complexity, the clinical and logistic setting and the operator expertise.
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He Y, Northrup H, Le H, Cheung AK, Berceli SA, Shiu YT. Medical Image-Based Computational Fluid Dynamics and Fluid-Structure Interaction Analysis in Vascular Diseases. Front Bioeng Biotechnol 2022; 10:855791. [PMID: 35573253 PMCID: PMC9091352 DOI: 10.3389/fbioe.2022.855791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 01/17/2023] Open
Abstract
Hemodynamic factors, induced by pulsatile blood flow, play a crucial role in vascular health and diseases, such as the initiation and progression of atherosclerosis. Computational fluid dynamics, finite element analysis, and fluid-structure interaction simulations have been widely used to quantify detailed hemodynamic forces based on vascular images commonly obtained from computed tomography angiography, magnetic resonance imaging, ultrasound, and optical coherence tomography. In this review, we focus on methods for obtaining accurate hemodynamic factors that regulate the structure and function of vascular endothelial and smooth muscle cells. We describe the multiple steps and recent advances in a typical patient-specific simulation pipeline, including medical imaging, image processing, spatial discretization to generate computational mesh, setting up boundary conditions and solver parameters, visualization and extraction of hemodynamic factors, and statistical analysis. These steps have not been standardized and thus have unavoidable uncertainties that should be thoroughly evaluated. We also discuss the recent development of combining patient-specific models with machine-learning methods to obtain hemodynamic factors faster and cheaper than conventional methods. These critical advances widen the use of biomechanical simulation tools in the research and potential personalized care of vascular diseases.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - Hannah Northrup
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ha Le
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
- Vascular Surgery Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
| | - Yan Tin Shiu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
- *Correspondence: Yan Tin Shiu,
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Berhane H, Scott MB, Barker AJ, McCarthy P, Avery R, Allen B, Malaisrie C, Robinson JD, Rigsby CK, Markl M. Deep learning-based velocity antialiasing of 4D-flow MRI. Magn Reson Med 2022; 88:449-463. [PMID: 35381116 PMCID: PMC9050855 DOI: 10.1002/mrm.29205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 01/03/2023]
Abstract
Purpose To develop a convolutional neural network (CNN) for the robust and fast correction of velocity aliasing in 4D‐flow MRI. Methods This study included 667 adult subjects with aortic 4D‐flow MRI data with existing velocity aliasing (n = 362) and no velocity aliasing (n = 305). Additionally, 10 controls received back‐to‐back 4D‐flow scans with systemically varied velocity‐encoding sensitivity (vencs) at 60, 100, and 175 cm/s. The no‐aliasing data sets were used to simulate velocity aliasing by reducing the venc to 40%–70% of the original, alongside a ground truth locating all aliased voxels (153 training, 152 testing). The 152 simulated and 362 existing aliasing data sets were used for testing and compared with a conventional velocity antialiasing algorithm. Dice scores were calculated to quantify CNN performance. For controls, the venc 175‐cm/s scans were used as the ground truth and compared with the CNN‐corrected venc 60 and 100 cm/s data sets Results The CNN required 176 ± 30 s to perform compared with 162 ± 14 s for the conventional algorithm. The CNN showed excellent performance for the simulated data compared with the conventional algorithm (median range of Dice scores CNN: [0.89–0.99], conventional algorithm: [0.84–0.94], p < 0.001, across all simulated vencs) and detected more aliased voxels in existing velocity aliasing data sets (median detected CNN: 159 voxels [31–605], conventional algorithm: 65 [7–417], p < 0.001). For controls, the CNN showed Dice scores of 0.98 [0.95–0.99] and 0.96 [0.87–0.99] for venc = 60 cm/s and 100 cm/s, respectively, while flow comparisons showed moderate‐excellent agreement. Conclusion Deep learning enabled fast and robust velocity anti‐aliasing in 4D‐flow MRI.
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Affiliation(s)
- Haben Berhane
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Michael B. Scott
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Alex J. Barker
- Anschutz Medical CampusUniversity of ColoradoAuroraColoradoUSA
| | - Patrick McCarthy
- Division of Cardiac SurgeryNorthwestern MedicineChicagoIllinoisUSA
| | - Ryan Avery
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Brad Allen
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
| | - Chris Malaisrie
- Division of Cardiac SurgeryNorthwestern MedicineChicagoIllinoisUSA
| | - Joshua D. Robinson
- Department of Medical ImagingLurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Cynthia K. Rigsby
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
- Department of Medical ImagingLurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Michael Markl
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
- Department of RadiologyNorthwestern MedicineChicagoIllinoisUSA
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