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Garay J, Dunstan J, Uribe S, Sahli Costabal F. Physics-informed neural networks for parameter estimation in blood flow models. Comput Biol Med 2024; 178:108706. [PMID: 38879935 DOI: 10.1016/j.compbiomed.2024.108706] [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: 11/07/2023] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Physics-informed neural networks (PINNs) have emerged as a powerful tool for solving inverse problems, especially in cases where no complete information about the system is known and scatter measurements are available. This is especially useful in hemodynamics since the boundary information is often difficult to model, and high-quality blood flow measurements are generally hard to obtain. METHODS In this work, we use the PINNs methodology for estimating reduced-order model parameters and the full velocity field from scatter 2D noisy measurements in the aorta. Two different flow regimes, stationary and transient were studied. RESULTS We show robust and relatively accurate parameter estimations when using the method with simulated data, while the velocity reconstruction accuracy shows dependence on the measurement quality and the flow pattern complexity. Comparison with a Kalman filter approach shows similar results when the number of parameters to be estimated is low to medium. For a higher number of parameters, only PINNs were capable of achieving good results. CONCLUSION The method opens a door to deep-learning-driven methods in the simulations of complex coupled physical systems.
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Affiliation(s)
- Jeremías Garay
- Department of Mechanical and Metallurgical Engineering, Pontificia Universidad Católica de Chile, Chile; Center of Biomedical Imaging, Pontificia Universidad Católica de Chile, Chile; Millennium Institute for Intelligent Healthcare Engineering (iHealth), Chile
| | - Jocelyn Dunstan
- Department of Computer Science, Pontificia Universidad Católica de Chile, Chile; Institute for Mathematical and Computational Engineering, Pontificia Universidad Católica de Chile, Chile; Millennium Institute for Foundational Research on Data (IMFD), Chile
| | - Sergio Uribe
- Center of Biomedical Imaging, Pontificia Universidad Católica de Chile, Chile; Millennium Institute for Intelligent Healthcare Engineering (iHealth), Chile; Department of Medical Imaging and Radiation Sciences, Monash University, Australia; Department of Radiology, Pontificia Universidad Católica de Chile, Chile
| | - Francisco Sahli Costabal
- Department of Mechanical and Metallurgical Engineering, Pontificia Universidad Católica de Chile, Chile; Millennium Institute for Intelligent Healthcare Engineering (iHealth), Chile; Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Chile.
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Nii M, Enomoto N, Ishida M, Magawa S, Takakura S, Maki S, Tanaka K, Toriyabe K, Tanaka H, Kondo E, Sakuma H, Ikeda T. Two-dimensional phase-contrast MRI reveals changes in uterine arterial blood flow in pregnant women administered tadalafil for fetal growth restriction. Placenta 2024; 146:1-8. [PMID: 38157651 DOI: 10.1016/j.placenta.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/15/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION We aimed to examine the effect of uterine arterial (UtA) blood flow changes after tadalafil treatment for fetal growth restriction (FGR) using two-dimensional (2D) phase-contrast magnetic resonance imaging (PC-MRI). METHODS We recruited 14 pregnant women with FGR aged 20-44 years, at ≥20 weeks' gestation, between May 2019 and July 2020. They underwent 2D PC-MRI for UtA blood flow measurement 3 days (interquartile range: 2-4) after diagnosis. This group (FGR group) was compared with 14 gestational age (GA)-matched healthy pregnant women (control group). Six patients in the FGR group received treatment with tadalafil administered at 20 mg twice daily after the first MRI until delivery. They underwent a second MRI a week later. RESULTS The median total UtA blood/body surface area was 420 mL/min/m2 (290-494) in the FGR group and 547 mL/min/m2 (433-681) in the control group (p = 0.01). Percent increase in blood flow were significantly different between the FGR cases treated with tadalafil and control at 15.8 % (14.3-21.3) and 4.2 % (3.6-8.7), respectively (p = 0.03). DISCUSSION UtA blood flow in pregnant women with FGR was significantly lower than that in healthy pregnant women. Tadalafil is expected to improve UtA blood flow, thereby improving placental function in pregnant patients with FGR.
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Affiliation(s)
- Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan.
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Edobashi, Tsu, Mie, Japan
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Proffitt EK, Kaproth-Joslin K, Chaturvedi A, Hobbs SK. Role of Magnetic Resonance Imaging in Transcatheter Structural Heart Disease Interventions. Semin Roentgenol 2024; 59:20-31. [PMID: 38388093 DOI: 10.1053/j.ro.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | | | - Abhishek Chaturvedi
- Department of Imaging Sciences, Division of Cardiothoracic Imaging, University of Rochester Medical Center, Rochester, NY.
| | - Susan K Hobbs
- University of Rochester Medical Center, Rochester, NY
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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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Caro-Domínguez P, Secinaro A, Valverde I, Fouilloux V. Imaging and surgical management of congenital heart diseases. Pediatr Radiol 2023; 53:677-694. [PMID: 36334120 DOI: 10.1007/s00247-022-05536-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/01/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
Congenital heart disease affects approximately 1% of live births per year. In recent years, there has been a decrease in the morbidity and mortality of these cases due to advances in medical and surgical care. Imaging plays a key role in the management of these children, with chest radiography, echocardiography and chest ultrasound the first diagnostic tools, and cardiac computed tomography, catheterization and magnetic resonance imaging reserved to assess better the anatomy and physiology of the most complex cases. This article is a beginner's guide to the anatomy of the most frequent congenital heart diseases (atrial and ventricular septal defects, abnormal pulmonary venous connections, univentricular heart, tetralogy of Fallot, transposition of the great arteries and coarctation of the aorta), their surgical management, the most common postsurgical complications, deciding which imaging modality is needed, and when and how to image gently.
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Affiliation(s)
- Pablo Caro-Domínguez
- Pediatric Radiology Unit, Department of Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, Seville, Spain.
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Israel Valverde
- Pediatric Cardiology Unit and Cardiovascular Pathology Unit, Hospital Universitario Virgen del Rocio and Institute of Biomedicine of Seville, Seville, Spain
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Virginie Fouilloux
- Department of Congenital and Pediatric Cardiac Surgery, Timone Children Hospital, Marseille, France
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Khanna NN, Maindarkar M, Puvvula A, Paul S, Bhagawati M, Ahluwalia P, Ruzsa Z, Sharma A, Munjral S, Kolluri R, Krishnan PR, Singh IM, Laird JR, Fatemi M, Alizad A, Dhanjil SK, Saba L, Balestrieri A, Faa G, Paraskevas KI, Misra DP, Agarwal V, Sharma A, Teji J, Al-Maini M, Nicolaides A, Rathore V, Naidu S, Liblik K, Johri AM, Turk M, Sobel DW, Pareek G, Miner M, Viskovic K, Tsoulfas G, Protogerou AD, Mavrogeni S, Kitas GD, Fouda MM, Kalra MK, Suri JS. Vascular Implications of COVID-19: Role of Radiological Imaging, Artificial Intelligence, and Tissue Characterization: A Special Report. J Cardiovasc Dev Dis 2022; 9:jcdd9080268. [PMID: 36005433 PMCID: PMC9409845 DOI: 10.3390/jcdd9080268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/30/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022] Open
Abstract
The SARS-CoV-2 virus has caused a pandemic, infecting nearly 80 million people worldwide, with mortality exceeding six million. The average survival span is just 14 days from the time the symptoms become aggressive. The present study delineates the deep-driven vascular damage in the pulmonary, renal, coronary, and carotid vessels due to SARS-CoV-2. This special report addresses an important gap in the literature in understanding (i) the pathophysiology of vascular damage and the role of medical imaging in the visualization of the damage caused by SARS-CoV-2, and (ii) further understanding the severity of COVID-19 using artificial intelligence (AI)-based tissue characterization (TC). PRISMA was used to select 296 studies for AI-based TC. Radiological imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound were selected for imaging of the vasculature infected by COVID-19. Four kinds of hypotheses are presented for showing the vascular damage in radiological images due to COVID-19. Three kinds of AI models, namely, machine learning, deep learning, and transfer learning, are used for TC. Further, the study presents recommendations for improving AI-based architectures for vascular studies. We conclude that the process of vascular damage due to COVID-19 has similarities across vessel types, even though it results in multi-organ dysfunction. Although the mortality rate is ~2% of those infected, the long-term effect of COVID-19 needs monitoring to avoid deaths. AI seems to be penetrating the health care industry at warp speed, and we expect to see an emerging role in patient care, reduce the mortality and morbidity rate.
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Affiliation(s)
- Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Annu’s Hospitals for Skin and Diabetes, Nellore 524101, India
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Mrinalini Bhagawati
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Puneet Ahluwalia
- Max Institute of Cancer Care, Max Super Specialty Hospital, New Delhi 110017, India
| | - Zoltan Ruzsa
- Invasive Cardiology Division, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22904, USA
| | - Smiksha Munjral
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Raghu Kolluri
- Ohio Health Heart and Vascular, Columbus, OH 43214, USA
| | | | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA 94574, USA
| | - Mostafa Fatemi
- Department of Physiology & Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Surinder K. Dhanjil
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy
| | - Antonella Balestrieri
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, 09124 Cagliari, Italy
| | | | - Durga Prasanna Misra
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vikas Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Aman Sharma
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Jagjit Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON L4Z 4C4, Canada
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA 95119, USA
| | - Subbaram Naidu
- Electrical Engineering Department, University of Minnesota, Duluth, MN 55812, USA
| | - Kiera Liblik
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, 27753 Delmenhorst, Germany
| | - David W. Sobel
- Rheumatology Unit, National Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI 02912, USA
| | - Martin Miner
- Men’s Health Centre, Miriam Hospital Providence, Providence, RI 02906, USA
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia
| | - George Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Athanasios D. Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Centre, 17674 Athens, Greece
| | - George D. Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Manudeep K. Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Correspondence: ; Tel.: +1-916-749-5628
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Nolte D, Bertoglio C. Inverse problems in blood flow modeling: A review. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3613. [PMID: 35526113 PMCID: PMC9541505 DOI: 10.1002/cnm.3613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/29/2021] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
Mathematical and computational modeling of the cardiovascular system is increasingly providing non-invasive alternatives to traditional invasive clinical procedures. Moreover, it has the potential for generating additional diagnostic markers. In blood flow computations, the personalization of spatially distributed (i.e., 3D) models is a key step which relies on the formulation and numerical solution of inverse problems using clinical data, typically medical images for measuring both anatomy and function of the vasculature. In the last years, the development and application of inverse methods has rapidly expanded most likely due to the increased availability of data in clinical centers and the growing interest of modelers and clinicians in collaborating. Therefore, this work aims to provide a wide and comparative overview of literature within the last decade. We review the current state of the art of inverse problems in blood flows, focusing on studies considering fully dimensional fluid and fluid-solid models. The relevant physical models and hemodynamic measurement techniques are introduced, followed by a survey of mathematical data assimilation approaches used to solve different kinds of inverse problems, namely state and parameter estimation. An exhaustive discussion of the literature of the last decade is presented, structured by types of problems, models and available data.
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Affiliation(s)
- David Nolte
- Bernoulli InstituteUniversity of GroningenGroningenThe Netherlands
- Center for Mathematical ModelingUniversidad de ChileSantiagoChile
- Department of Fluid DynamicsTechnische Universität BerlinBerlinGermany
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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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Kristiansen M, Lindén C, Qvarlander S, Wåhlin A, Ambarki K, Hallberg P, Eklund A, Jóhannesson G. Feasibility of MRI to assess differences in ophthalmic artery blood flow rate in normal tension glaucoma and healthy controls. Acta Ophthalmol 2021; 99:e679-e685. [PMID: 33210819 PMCID: PMC8451810 DOI: 10.1111/aos.14673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Purpose To examine feasibility of phase‐contrast magnetic resonance imaging (PCMRI) and to assess blood flow rate in the ophthalmic artery (OA) in patients with normal tension glaucoma (NTG) compared with healthy controls. Methods Sixteen patients with treated NTG and 16 age‐ and sex‐matched healthy controls underwent PCMRI using a 3‐Tesla scanner and ophthalmological examinations. OA blood flow rate was measured using a 2D PCMRI sequence with a spatial resolution of 0.35 mm2. Results The blood flow rate in the NTG group was 9.6 ± 3.9 ml/min [mean ± SD] compared with 11.9 ± 4.8 ml/min in the control group. Resistance Index (RI) and Pulsatility Index (PI) were 0.73 ± 0.08 and 1.36 ± 0.29, respectively, in the NTG group and 0.68 ± 0.13 and 1.22 ± 0.40, respectively, in the healthy group. The mean visual field index (VFI) was 46% ± 25 for the worse NTG eyes. The measured differences observed between the NTG group and the control group in blood flow rate (p = 0.12), RI (p = 0.18) and PI (p = 0.27) were non‐significant. Conclusions This case–control study, using PCMRI, showed a slight, but non‐significant, reduction in OA blood flow rate in the NTG patients compared with the healthy controls. These results indicate that blood flow may be of importance in the pathogenesis of NTG. Considering that only a limited portion of the total OA blood flow supplies the ocular system and the large inter‐individual differences, a larger study or more advanced PCMRI technique might give the answer.
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Affiliation(s)
- Martin Kristiansen
- Department of Clinical Sciences Ophthalmology Umeå University Umeå Sweden
| | - Christina Lindén
- Department of Clinical Sciences Ophthalmology Umeå University Umeå Sweden
| | - Sara Qvarlander
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
| | - Anders Wåhlin
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
- Umeå Center for Functional Brain Imaging Umeå University Umeå Sweden
| | - Khalid Ambarki
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
| | - Per Hallberg
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
- Dept. of Applied Physics and Electronics Umeå University Umeå Sweden
| | - Anders Eklund
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
- Centre for Biomedical Engineering and Physics Umeå University Umeå Sweden
| | - Gauti Jóhannesson
- Department of Clinical Sciences Ophthalmology Umeå University Umeå Sweden
- Wallenberg Center for Molecular Medicine Umeå University Umeå Sweden
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Hemodynamic Changes in the Sigmoid Sinus of Patients With Pulsatile Tinnitus Induced by Sigmoid Sinus Wall Anomalies. Otol Neurotol 2021; 41:e163-e167. [PMID: 31663989 DOI: 10.1097/mao.0000000000002512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study is to investigate the hemodynamic changes of pulsatile tinnitus (PT) patients induced by sigmoid sinus wall anomalies (SSWA). STUDY DESIGN Prospective study. SETTING Tertiary referral university hospital. PATIENTS Fifteen unilateral PT patients with SSWA identified on computed tomography images and surgery and 15 age-, sex-, and body mass index-matched healthy volunteers underwent velocity-encoded, cine magnetic resonance imaging. INTERVENTION Hemodynamic data in sigmoid sinus were obtained from velocity-encoded, cine magnetic resonance imaging, and compared between PT patients and controls. MAIN OUTCOME MEASURES Heart rate was recorded. Cross-sectional area (CSA), peak positive velocity (PPV), average positive flow volume per beat (APFV/beat), average flow volume per beat (AFV/beat), peak negative velocity (PNV), and average negative flow volume per beat (ANFV/beat) were measured. Average flow volume per minute (AFV/min), average positive flow volume per minute (APFV/min), average negative flow volume per minute (ANFV/min), average positive velocity (APV), average negative velocity (ANV), and regurgitation fraction (RF) were calculated. RESULTS APV at PT side of patients was 13.4 ± 3.3 cm/s, which was significantly slower than that at corresponding side of controls (15.8 ± 2.6 cm/s). PNV and RF at PT side of patients were 21.0 ± 15.4 cm/s and 2.4% respectively, which were significantly higher than those values at corresponding side of controls (both of them were 0). HR, CSA, PPV, APFV/beat, APFV/min, AFV/beat, AFV/min, ANV, ANFV/beat, and ANFV/min were 69.8 ± 9.4 beat/min, 48.4 ± 17 mm, 31.4 ± 5.9 cm/s, 5.4 ± 1.8 ml/beat, 373.9 ± 117.7 ml/min, 5.1 ± 2.0 ml/beat, 352.0 ± 134.6 ml/min, 2 (0-4.9) cm/s, 1 (0-2.7) ml/beat, and 4.1 (0-141.3) ml/min at PT side of patients, and 67.4 ± 7.8 beat/min, 38.2 ± 18 mm, 29.9 ± 3.9 cm/s, 5.3 ± 2.0 ml/beat, 350.3 ± 125.3 ml/min, 5.1 ± 1.9 ml/beat, 340.5 ± 117.9 ml/min, 0 (0-2.1) cm/s, 0 (0-0.8) ml/beat, and 0 (0-55.4) ml/min at corresponding side of controls. These hemodynamics were not significantly different between groups. CONCLUSION APV, PNV, and RF changes take place in SSWA patients, which may be associated with the occurrence of PT and have the potential value to improve accurate etiological diagnosis and predict treatment success.
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Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
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Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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Cardiac magnetic resonance imaging and computed tomography for the pediatric cardiologist. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Aortic coarctation is a discrete narrowing of the thoracic aorta. In addition to anatomic obstruction, it can be considered an aortopathy with abnormal vascular properties characterized by stiffness and impaired relaxation. There are surgical and transcatheter techniques to address the obstruction but, despite relief, patients with aortic coarctation are at risk for hypertension, aortic complications, and abnormalities with left ventricular performance. This review covers the etiology, pathophysiology, diagnosis, and management of adults with aortic coarctation, with emphasis on multimodality imaging characteristics and lifelong surveillance to identify long-term complications.
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Affiliation(s)
- Yuli Y Kim
- Philadelphia Adult Congenital Heart Center, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine and Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Lauren Andrade
- Philadelphia Adult Congenital Heart Center, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine and Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Stephen C Cook
- Adult Congenital Heart Disease Program, Congenital Heart Center, Helen DeVos Children's Hospital, Frederik Meijer Heart & Vascular Institute, Pediatrics and Human Development, Michigan State University, 25 Michigan Street NE Suite 4200, Grand Rapids, MI 49503, USA
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Ludwig DR, Shetty AS, Broncano J, Bhalla S, Raptis CA. Magnetic Resonance Angiography of the Thoracic Vasculature: Technique and Applications. J Magn Reson Imaging 2020; 52:325-347. [PMID: 32061029 DOI: 10.1002/jmri.27067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance angiography (MRA) is a powerful clinical tool for evaluation of the thoracic vasculature. MRA can be performed on nearly any magnetic resonance imaging (MRI) scanner, and provides images of high diagnostic quality without the use of ionizing radiation. While computed tomographic angiography (CTA) is preferred in the evaluation of hemodynamically unstable patients, MRA represents an important tool for evaluation of the thoracic vasculature in stable patients. Contrast-enhanced MRA is generally performed unless there is a specific contraindication, as it shortens the duration of the exam and provides images of higher diagnostic quality than noncontrast MRA. However, intravenous contrast is often not required to obtain a diagnostic evaluation for most clinical indications. Indeed, a variety of noncontrast MRA techniques are used for thoracic imaging, often in conjunction with contrast-enhanced MRA, each of which has a differing degree of reliance on flowing blood to produce the desired vascular signal. In this article we review contrast-enhanced MRA, with a focus on contrast agents, methods of bolus timing, and considerations in imaging acquisition. Next, we cover the mechanism of contrast, strengths, and weaknesses of various noncontrast MRA techniques. Finally, we present an approach to protocol development and review representative protocols used at our institution for a variety of thoracic applications. Further attention will be devoted to additional techniques employed to address specific clinical questions, such as delayed contrast-enhanced imaging, provocative maneuvers, electrocardiogram and respiratory gating, and phase-contrast imaging. The purpose of this article is to review basic techniques and methodology in thoracic MRA, discuss an approach to protocol development, and illustrate commonly encountered pathology on thoracic MRA examinations. Level of Evidence 5 Technical Efficacy Stage 3.
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Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jordi Broncano
- Cardiothoracic Imaging Section, Health Time, Hospital de la Cruz Roja and San Juan de Dios, Cordoba, Spain
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Mercuri M, Wustmann K, von Tengg-Kobligk H, Göksu C, Hose DR, Narracott A. Subject-specific simulation for non-invasive assessment of aortic coarctation: Towards a translational approach. Med Eng Phys 2020; 77:69-79. [PMID: 31926831 DOI: 10.1016/j.medengphy.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022]
Abstract
We present a multi-scale CFD-based study conducted in a cohort of 11 patients with coarctation of the aorta (CoA). The study explores the potential for implementation of a workflow using non-invasive routinely collected medical imaging data and clinical measurements to provide a more detailed insight into local aortic haemodynamics in order to support clinical decision making. Our approach is multi-scale, using a reduced-order model (1D/0D) and an optimization process for the personalization of patient-specific boundary conditions and aortic vessel wall parameters from non-invasive measurements, to inform a more complex model (3D/0D) representing 3D aortic patient-specific anatomy. The reliability of the modelling approach is investigated by comparing 3D/0D model pressure drop estimation with measured peak gradients recorded during diagnostic cardiac catheterization and 2D PC-MRI flow rate measurements in the descending aorta. The current study demonstrated that the proposed approach requires low levels of user interaction, making it suitable for the clinical setting. The agreement between computed blood pressure drop and catheter measurements is 10 ± 8 mmHg at the coarctation site. The comparison between CFD derived and catheter measured pressure gradients indicated that the model has to be improved, suggesting the use of time varying pressure waveforms to further optimize the tuning process and modelling assumptions.
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Affiliation(s)
- Massimiliano Mercuri
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; Therenva, Rennes, France; INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, U.K..
| | - Kerstin Wustmann
- Center for Congenital Heart Disease, Cardiac Magnetic Resonance Imaging, Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Bern University Hospital, Bern, Switzerland
| | | | - D Rodney Hose
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Bern University Hospital, Bern, Switzerland; Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | - Andrew Narracott
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, U.K
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Ordovas K. Invited Commentary on “Four-dimensional Flow MRI,” with Response from Dr Azarine et al. Radiographics 2019; 39:648-650. [DOI: 10.1148/rg.2019190035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Karen Ordovas
- Department of Radiology, University of California, San Francisco San Francisco, California
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Abstract
A number of congenital defects and acquired disease processes affect the thoracic aorta, and traditionally, computed tomography (CT) has been the mainstay of imaging, especially in evaluation of the acute aorta. However, recent advances in magnetic resonance (MR) imaging such as electrocardiographically (ECG) triggered breath-hold sequences and ultrafast 3-dimensional MR angiography (MRA) are bringing MR imaging to the forefront of imaging of the thoracic aorta. By providing high-resolution morphological imaging and sophisticated vascular flow analysis for functional data, this modality can provide a comprehensive, reproducible evaluation of the thoracic aorta. In this review, we discuss the role of MR imaging in the evaluation of thoracic aorta pathology along with pertinent examples of aortic abnormalities.
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Affiliation(s)
- John P Lichtenberger
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Derek F Franco
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jason S Kim
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Abstract
Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the varied manifestations of vascular disease. Vascular imaging encompasses a wide variety of pathology. Designing vascular imaging protocols can be challenging owing to the non-uniform velocity of blood in the aorta, differences in cardiac output between patients, and the effect of different disease states on blood flow. In this review, we provide the rationale behind—and a practical guide to—designing and implementing straightforward vascular computed tomography (CT) and magnetic resonance imaging (MRI) protocols. Teaching Points • There is a wide range of vascular pathologies requiring bespoke imaging protocols. • Variations in cardiac output and non-uniform blood velocity complicate vascular imaging. • Contrast media dose, injection rate and duration affect arterial enhancement in CTA. • Iterative CT reconstruction can improve image quality and reduce radiation dose. • MRA is of particular value when imaging small arteries and venous studies.
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20
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Fulton N, Rajiah P. Utility of magnetic resonance imaging in the evaluation of left ventricular thickening. Insights Imaging 2017; 8:279-293. [PMID: 28281159 PMCID: PMC5359150 DOI: 10.1007/s13244-017-0549-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 12/14/2022] Open
Abstract
Left ventricular (LV) thickening can be due to hypertrophy (concentric, asymmetric, eccentric) or remodelling (concentric or asymmetric). Pathological thickening may be caused by pressure overload, volume overload, infiltrative disorders, hypertrophic cardiomyopathy, athlete's heart or neoplastic infiltration. Magnetic resonance imaging (MRI) plays an important role in the comprehensive evaluation of LV thickening, including: establishing diagnosis, determining LV geometry, establishing aetiology, quantification, identifying prognostic factors, serial follow-up and treatment response. In this article, we review the aetiologies and pathophysiology of LV thickening, and demonstrate the comprehensive role of MRI in the evaluation of LV thickening. TEACHING POINTS • MRI plays an important role in the evaluation of LV thickening. • LV thickening can be due to either hypertrophy or remodelling. • Pathological thickening can be due to pressure/volume overload or infiltrative disorders.
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Affiliation(s)
- Nicholas Fulton
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA.
- Department of Radiology Cardiothoracic Imaging, UT Southwestern Medical Center, E6.120 B, Mail code 9316, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8896, USA.
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21
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Yiğit H, Önder A, Özgür S, Aycan Z, Karademir S, Doğan V. Cardiac MRI and 3D contrast-enhanced MR angiography in pediatric and young adult patients with Turner syndrome. Turk J Med Sci 2017; 47:127-133. [PMID: 28263479 DOI: 10.3906/sag-1511-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/14/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM This study aimed to describe the spectrum and frequency of cardiovascular abnormalities in pediatric and young adult patients with Turner syndrome (TS) using cardiac MRI and MR angiography. MATERIALS AND METHODS This prospective study consisted of 47 female patients of pediatric age and young adults with a karyotypically confirmed diagnosis of TS. All patients underwent cardiac MRI and contrast-enhanced MR angiography. A second examination after 9-26 months was performed for 28 of these patients. RESULTS Elongation of the transverse aortic arch (ETA) was the most frequent abnormality with a rate of 37%. The rate of partial anomalous pulmonary venous connection (PAPVC) was 21.7%, bicuspid aortic valve (BAV) was 19.6%, coarctation was 6.5%, ascending aorta dilatation was 28.3%, and descending aorta dilatation was 15.2%. The diameters of the aorta and the rate of aortic dilatation per unit of time was greater in the patients with BAV (P < 0.05). ETA was less observed in the patients who were receiving growth hormone therapy (P < 0.05). CONCLUSION The most common cardiovascular abnormalities in TS patients are aortic arch anomalies such as ETA and coarctation, aortic dilatation, PAPVCs, and BAV. The presence of BAV is an important risk factor for the aortic dilatation.
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Affiliation(s)
- Hasan Yiğit
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Aşan Önder
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Senem Özgür
- Department of Pediatric Cardiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Selmin Karademir
- Department of Pediatric Cardiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Vehbi Doğan
- Department of Pediatric Cardiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
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Whitlock MC, Hundley WG. Noninvasive Imaging of Flow and Vascular Function in Disease of the Aorta. JACC Cardiovasc Imaging 2016; 8:1094-1106. [PMID: 26381770 DOI: 10.1016/j.jcmg.2015.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 02/06/2023]
Abstract
With advancements in technology and a better understanding of human cardiovascular physiology, research as well as clinical care can go beyond dimensional anatomy offered by traditional imaging and investigate aortic functional properties and the impact disease has on this function. Linking the knowledge of the histopathological changes with the alterations in aortic function observed on noninvasive imaging results in a better understanding of disease pathophysiology. Translating this to clinical medicine, these noninvasive imaging assessments of aortic function are proving to be able to diagnose disease, better predict risk, and assess response to therapies. This review is designed to summarize the various hemodynamic measures that can characterize the aorta, the various noninvasive techniques, and applications for various disease states.
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Affiliation(s)
- Matthew C Whitlock
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Radiological Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Baez JC, Seethamraju RT, Mulkern R, Ciet P, Lee EY. Pediatric Chest MR Imaging: Sedation, Techniques, and Extracardiac Vessels. Magn Reson Imaging Clin N Am 2016; 23:321-35. [PMID: 25952523 DOI: 10.1016/j.mric.2015.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Thoracic MR imaging in the pediatric population provides unique challenges requiring tailored protocols and a practical approach to pediatric issues, such as patient motion and sedation. Concern regarding the use of ionizing radiation in the pediatric population has continued to advance the use of MR imaging despite these challenges. This article provides a practical approach to thoracic vascular MR imaging with special attention paid to pediatric-specific issues such as sedation. Thoracic vascular anatomy and pathology are discussed with an emphasis on protocols that can facilitate accurate diagnosis.
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Affiliation(s)
- Juan C Baez
- Mid-Atlantic Permanente Medical Group, 2101 East Jefferson Street, Rockville, MD 20852, USA; Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Ravi T Seethamraju
- Magnetic Resonance, Research and Development, Siemens Healthcare, 1620 Tremont St., Boston, MA 02120, USA
| | - Robert Mulkern
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Pierluigi Ciet
- Department of Radiology and Pediatric Pulmonology, Sophia Children's Hospital, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands; Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Multimodality Noninvasive Imaging of Thoracic Aortic Aneurysms: Time to Standardize? Can J Cardiol 2016; 32:48-59. [DOI: 10.1016/j.cjca.2015.09.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 01/16/2023] Open
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Fasquel JB, Lécluse A, Cavaro-Ménard C, Willoteaux S. A semi-automated method for measuring the evolution of both lumen area and blood flow in carotid from Phase Contrast MRI. Comput Biol Med 2015; 66:269-77. [PMID: 26453757 DOI: 10.1016/j.compbiomed.2015.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/16/2015] [Accepted: 09/19/2015] [Indexed: 11/26/2022]
Abstract
Phase-Contrast (PC) velocimetry Magnetic Resonance Imaging (MRI) is a useful modality to explore cardiovascular pathologies, but requires the automatic segmentation of vessels and the measurement of both lumen area and blood flow evolutions. In this paper, we propose a semi-automated method for extracting lumen boundaries of the carotid artery and compute both lumen area and blood flow evolutions over the cardiac cycle. This method uses narrow band region-based active contours in order to correctly capture the lumen boundary without being corrupted by surrounding structures. This approach is compared to traditional edge-based active contours, considered in related works, which significantly underestimate lumen area and blood flow. Experiments are performed using both a sequence of a homemade phantom and sequences of 20 real carotids, including a comparison with manual segmentation performed by a radiologist expert. Results obtained on the phantom sequence show that the edge-based approach leads to an underestimate of carotid lumen area and related flows of respectively 18.68% and 4.95%. This appears significantly larger than weak errors obtained using the region-based approach (respectively 2.73% and 1.23%). Benefits appear even better on the real sequences. The edge-based approach leads to underestimates of 40.88% for areas and 13.39% for blood flows, compared to limited errors of 7.41% and 4.6% with our method. Experiments also illustrate the high variability and therefore the lack of reliability of manual segmentation.
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Affiliation(s)
- Jean-Baptiste Fasquel
- LARIS Laboratory, EA4094, University of Angers, 62 avenue Notre Dame du Lac, 49000 Angers, France.
| | - Aldéric Lécluse
- Radiology Department, University Hospital, 4 rue Larrey, 49933 Angers, France
| | - Christine Cavaro-Ménard
- LARIS Laboratory, EA4094, University of Angers, 62 avenue Notre Dame du Lac, 49000 Angers, France
| | - Serge Willoteaux
- Radiology Department, University Hospital, 4 rue Larrey, 49933 Angers, France
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Marin A, Weir-McCall JR, Webb DJ, van Beek EJR, Mirsadraee S. Imaging of cardiovascular risk in patients with Turner's syndrome. Clin Radiol 2015; 70:803-14. [PMID: 25917542 PMCID: PMC4509713 DOI: 10.1016/j.crad.2015.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/17/2015] [Accepted: 03/19/2015] [Indexed: 01/14/2023]
Abstract
Turner's syndrome is a disorder defined by an absent or structurally abnormal second X chromosome and affects around 1 in 2000 newborn females. The standardised mortality ratio in Turner's syndrome is around three-times higher than in the general female population, mainly as a result of cardiovascular disorders. Most striking is the early age at which Turner's syndrome patients develop the life-threatening complications of cardiovascular disorders compared to the general population. The cardiovascular risk stratification in Turner's syndrome is challenging and imaging is not systematically used. The aim of this article is to review cardiovascular risks in this group of patients and discuss a systematic imaging approach for early identification of cardiovascular disorders in these patients.
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Affiliation(s)
- A Marin
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - J R Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | - D J Webb
- Queen's Medical Research Institute, University of Edinburgh/BHF Centre for Cardiovascular Science, Edinburgh EH16 4TJ, UK
| | - E J R van Beek
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - S Mirsadraee
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK.
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Coarctation of the aorta: management, indications for intervention, and advances in care. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:341. [PMID: 25143119 DOI: 10.1007/s11936-014-0341-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OPINION STATEMENT Coarctation of the aorta (CoAo) accounts for 9 % of congenital heart defects. Balloon angioplasty has been the conventional endovascular treatment of choice for both native and recurrent coarctation in adults. Recent advancement in stent technology with the development of the covered stents has enhanced the scope for percutaneous management of both native CoAo and post-surgical CoAo. Stent implantation provides better hemodynamic results with larger acute diameter gain and better long-term hemodynamic benefit. Stenting also decreases the incidence of aneurysm formation. The development of biodegradable stents may revolutionize the percutaneous management of coarctation, as the degradation of the stent scaffold within 6 months of implantation will further decrease the incidence of restenosis. In the future stenting may suffice and obviate the need for open repair. Until then, surgical repair of CoAo is the preferred method in both infants and complicated lesions, leaving stenting to adults with focal and uncomplicated disease.
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Hoey ETD, Pakala V, Teoh JK, Simpson H. The role of imaging in hypertensive heart disease. Int J Angiol 2014; 23:85-92. [PMID: 25075160 DOI: 10.1055/s-0034-1370885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hypertensive heart disease (HHD) describes a spectrum of target organ response that includes left ventricular hypertrophy, systolic, and diastolic dysfunction. A variety of imaging techniques can be used to assess the various aspects of HHD. Echocardiography has for many years been the main imaging technique in the evaluation of HHD, but there is an increasing role for cardiovascular magnetic resonance (CMR) imaging due to its ability to provide an unrestricted field of view and noninvasive tissue characterization. This article reviews the current role of imaging for HHD with particular focus on echocardiography and CMR applications.
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Affiliation(s)
- Edward T D Hoey
- Department of Radiology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Vijayabhaskar Pakala
- Department of Radiology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Jun K Teoh
- Department of Cardiology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Helen Simpson
- Department of Cardiology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
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Schoennagel BP, Remus CC, Yamamura J, Kording F, Tavares de Sousa M, de Sousa MT, Hecher K, Fischer R, Ueberle F, Boehme M, Adam G, Kooijman H, Wedegaertner U. Fetal blood flow velocimetry by phase-contrast MRI using a new triggering method and comparison with Doppler ultrasound in a sheep model: a pilot study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 27:237-44. [PMID: 23934159 DOI: 10.1007/s10334-013-0397-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/09/2013] [Accepted: 07/26/2013] [Indexed: 02/03/2023]
Abstract
OBJECT We present the first study demonstrating the feasibility of antenatal blood flow velocimetry performing ECG triggered phase-contrast (PC)-MRI in the fetal aorta by using a newly developed Doppler ultrasound trigger. MATERIALS AND METHODS Five pregnant sheep carrying singleton fetuses (gestational age 121 days) were anesthetized to undergo fetal 2D PC-MRI in the fetal descending aorta (1.5 T) using a newly developed MR-compatible Doppler ultrasound trigger for fetal cardiac triggering. Inter-operator variability was assessed for PC-MR measurements and reproducibility was tested by repeated scans in one fetus. Inter-modality comparison was performed by Doppler ultrasound velocimetry. RESULTS Fetal cardiac triggering was possible in all examinations. PC-MR velocimetry revealed a mean inter-operator variability of 3 ± 5%. Average peak systolic flow velocities of 62.5 ± 4.4 cm/s were in good agreement with Doppler ultrasound measurements of 62.0 ± 9.2 cm/s (p (Lord's U test) ≫ 0.05). CONCLUSION Fetal PC-MR velocimetry was successfully performed using the newly developed MR-compatible Doppler ultrasound trigger for intrauterine fetal cardiac triggering, demonstrating high inter-operator and inter-modality agreement. This new method has the high potential for alternative assessment of hemodynamic decompensation of the fetal circulation.
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Affiliation(s)
- Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany,
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Dolic K, Siddiqui AH, Karmon Y, Marr K, Zivadinov R. The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants. BMC Med 2013; 11:155. [PMID: 23806142 PMCID: PMC3699429 DOI: 10.1186/1741-7015-11-155] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/30/2013] [Indexed: 02/08/2023] Open
Abstract
The extra-cranial venous system is complex and not well studied in comparison to the peripheral venous system. A newly proposed vascular condition, named chronic cerebrospinal venous insufficiency (CCSVI), described initially in patients with multiple sclerosis (MS) has triggered intense interest in better understanding of the role of extra-cranial venous anomalies and developmental variants. So far, there is no established diagnostic imaging modality, non-invasive or invasive, that can serve as the "gold standard" for detection of these venous anomalies. However, consensus guidelines and standardized imaging protocols are emerging. Most likely, a multimodal imaging approach will ultimately be the most comprehensive means for screening, diagnostic and monitoring purposes. Further research is needed to determine the spectrum of extra-cranial venous pathology and to compare the imaging findings with pathological examinations. The ability to define and reliably detect noninvasively these anomalies is an essential step toward establishing their incidence and prevalence. The role for these anomalies in causing significant hemodynamic consequences for the intra-cranial venous drainage in MS patients and other neurologic disorders, and in aging, remains unproven.
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Affiliation(s)
- Kresimir Dolic
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High St, Buffalo, NY 14203, USA
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31
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Non-Invasive Hemodynamic Assessment of Aortic Coarctation: Validation with In Vivo Measurements. Ann Biomed Eng 2012; 41:669-81. [DOI: 10.1007/s10439-012-0715-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/27/2012] [Indexed: 11/26/2022]
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32
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Di Cesare E, Cademartiri F, Carbone I, Carriero A, Centonze M, De Cobelli F, De Rosa R, Di Renzi P, Esposito A, Faletti R, Fattori R, Francone M, Giovagnoni A, La Grutta L, Ligabue G, Lovato L, Marano R, Midiri M, Romagnoli A, Russo V, Sardanelli F, Natale L, Bogaert J, De Roos A. [Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging]. Radiol Med 2012. [PMID: 23184241 DOI: 10.1007/s11547-012-0899-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiac magnetic resonance (CMR) is considered an useful method in the evaluation of many cardiac disorders. Based on our experience and available literature, we wrote a document as a guiding tool in the clinical use of CMR. Synthetically we describe different cardiac disorders and express for each one a classification, I to IV, depending on the significance of diagnostic information expected.
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Affiliation(s)
- E Di Cesare
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università di L'Aquila, L'Aquila, Italy.
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Holloway BJ, Rosewarne D, Jones RG. Imaging of thoracic aortic disease. Br J Radiol 2012; 84 Spec No 3:S338-54. [PMID: 22723539 DOI: 10.1259/bjr/30655825] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aortic pathology can be more complex to understand on imaging than is initially appreciated. There are a number of imaging modalities that provide excellent assessment of aortic pathology and enable the accurate monitoring of disease. This review discusses the imaging of the most common disease processes that affect the aorta in adults, with the primary focus being on CT and MRI.
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Affiliation(s)
- B J Holloway
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
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Murillo H, Lane MJ, Punn R, Fleischmann D, Restrepo CS. Imaging of the Aorta: Embryology and Anatomy. Semin Ultrasound CT MR 2012; 33:169-90. [DOI: 10.1053/j.sult.2012.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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35
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Caroff J, Bière L, Trebuchet G, Nedelcu C, Sibileau E, Beregi JP, Aubé C, Furber A, Willoteaux S. Applications of phase-contrast velocimetry sequences in cardiovascular imaging. Diagn Interv Imaging 2012; 93:159-70. [DOI: 10.1016/j.diii.2012.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Geiger J, Markl M, Stiller B, Schlensak C, Arnold R. Iatrogenic neonatal type B aortic dissection: comprehensive MRI-based diagnosis and follow-up. Pediatr Radiol 2011; 41:1333-6. [PMID: 21674287 DOI: 10.1007/s00247-011-2066-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/29/2010] [Accepted: 12/20/2010] [Indexed: 11/28/2022]
Abstract
Neonatal aortic dissection is rare and most frequently iatrogenic. Decision making and appropriate imaging are highly challenging for pediatric cardiologists and radiologists. We present MRI and echocardiographic findings in the follow-up at 6 months of age of a boy with a conservatively treated iatrogenic neonatal aortic dissection (type B). To evaluate the morphology of the aortic arch and descending aorta, we carried out multidirectional time-resolved three-dimensional flow-analysis and contrast-enhanced MR angiography (CE-MRA). The MRI and Doppler echocardiographic results were closely comparable. Three-dimensional visualization helped assess details of blood flow acceleration and alteration caused by the dissection, and played a key role in our deciding not to treat surgically.
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Affiliation(s)
- Julia Geiger
- Department of Diagnostic Radiology and Medical Physics, University Hospital Freiburg, Hugstetter Str 55, 79106 Freiburg, Germany.
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37
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Muzzarelli S, Ordovas KG, Hope MD, Meadows JJ, Higgins CB, Meadows AK. Diagnostic value of the flow profile in the distal descending aorta by phase-contrast magnetic resonance for predicting severe coarctation of the aorta. J Magn Reson Imaging 2011; 33:1440-6. [DOI: 10.1002/jmri.22566] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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38
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Winner MW, Raman SV, Chung YC, Simonetti OP, Mihai G, Cook SC. Post-interventional three-dimensional dark blood MRI in the adult with congenital heart disease. Int J Cardiol 2011; 158:267-71. [PMID: 21315462 DOI: 10.1016/j.ijcard.2011.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 01/11/2011] [Accepted: 01/14/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND Investigate a novel three-dimensional (3D) turbo spin echo (TSE) magnetic resonance imaging (MRI) sequence to assess stented segments in adults with congenital heart disease (CHD) after transcatheter intervention. METHODS Adults with CHD referred for computed tomography (CT) after transcatheter intervention underwent MR exam with a 3D respiratory gated TSE sequence. Data obtained at the time of the study included type of CHD, radiation dose, length of time between exams, and luminal diameters of stented segments from each exam. Continuous variables were analyzed using Student'st and Bland-Altman plots performed to analyze measurements obtained from both examinations. RESULTS Eleven patients underwent both examinations. Type of defects included coarctation of the aorta (n=6) and tetralogy of Fallot. Average radiation dose was 19.6 mSv and average time between CT and MRI was 99 ± 160 days. Luminal diameters of stented vessels correlated closely between TSE MRI and CT (r(2)=.85) with a bias toward overestimation with MRI (mean 22.4 ± 4.3mm and 20.9 ± 3.7 mm, p<.01). CONCLUSION This novel 3D respiratory gated TSE MR technique provides a feasible method to reduce metallic artifact and improve visualization of stented segments and surrounding anatomic structures without exposure to radiation.
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Affiliation(s)
- Marshall W Winner
- Department of Internal Medicine, Division of Cardiovascular Medicine, Adolescent/Adult Congenital Heart Disease Program, The Ross Heart Hospital, The Ohio State University, United States
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MRI assessment of thoracic stent grafts after emergency implantation in multi trauma patients: a feasibility study. Eur Radiol 2011; 21:1397-405. [PMID: 21331596 DOI: 10.1007/s00330-011-2074-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/13/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the feasibility of MRI for static and dynamic assessment of the deployment of thoracic aortic stent grafts after emergency implantation in trauma patients. METHODS Twenty patients initially presenting with a rupture of the thoracic aorta were enrolled in this study. All patients underwent thoracic endovascular aortic repair (TEVAR). The deployment of the implanted stent graft was assessed by CTA and MRI, comprising the assessment of the aortic arch with and without contrast agent, and the assessment of the motion of the stent graft over the cardiac cycle. RESULTS The stent graft geometry and motion over the cardiac cycle were assessable by MRI in all patients. Flow-mediated signal variations in areas of flow acceleration could be well visualised. No statistically significant differences in stent-graft diameters were observed between CT and MRI measurements. CONCLUSION MRI appears to be a valuable tool for the assessment of thoracic stent grafts. It shows similar performance in the accurate assessment of stent-graft dimensions to the current gold standard CTA. Its capability of providing additional functional information and the lack of ionising radiation and nephrotoxic contrast agents may make MRI a valuable tool for monitoring patients after TEVAR.
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Wintersperger BJ, Theisen D, Reiser MF. [MRI for therapy control in patients with aortic isthmus stenosis]. Radiologe 2010; 51:23-30. [PMID: 21113572 DOI: 10.1007/s00117-010-1997-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Aortic isthmus stenosis is the most common congenital aortic anomaly and is often a problem for therapy surveillance. In addition to possible comorbidities (e.g. bicuspid aortic valve) it is accompanied by various middle and long-term complications depending on the primary choice of the therapeutic procedure. Magnetic resonance imaging (MRI) plays an important role for the mostly young patients in the control of the aortic isthmus stenosis and therapy because it is non-invasive and there is no X-ray exposure. Radiologists should be well-informed on the principles of the therapeutic procedure in order to be competent in the interpretation of MRI findings. Due to the continuous development of MRI technology, techniques for functional evaluation (e.g. dynamic MRA, 4D PC flow measurement) are increasingly becoming available in addition to high-resolution MR angiography (MRA), which could predict the risk of possible complications, such as aneurysms. However, in this aspect further studies are necessary. Interventional therapy with stents and stent grafts is often employed for the therapy of possible complications following an operation (aneurysms, restenosis) but because of massive metal artefacts the use of MRI is often sometimes severely limited.
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Affiliation(s)
- B J Wintersperger
- Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland.
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41
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Frank L, Dillman JR, Parish V, Mueller GC, Kazerooni EA, Bell A, Attili AK. Cardiovascular MR Imaging of Conotruncal Anomalies. Radiographics 2010; 30:1069-94. [DOI: 10.1148/rg.304095158] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Babar JL, Jones RG, Hudsmith L, Steeds R, Guest P. Application of MR imaging in assessment and follow-up of congenital heart disease in adults. Radiographics 2010; 30:1145. [PMID: 20442335 DOI: 10.1148/rg.e40] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Judith L Babar
- Department of Radiology, University Hospital Birmingham, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TH, United Kingdom
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Optimization of MR phase-contrast-based flow velocimetry and shear stress measurements. Int J Cardiovasc Imaging 2009; 26 Suppl 1:133-42. [PMID: 20039134 DOI: 10.1007/s10554-009-9572-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 12/18/2009] [Indexed: 10/20/2022]
Abstract
This study was designed to measure the pixel-by-pixel flow velocity and shear stress from phase-contrast MR images. An optimized method was suggested and the use of the method was confirmed. A self-developed, straight steady flow model system was scanned by MRI with a velocity-encoded phase-contrast sequence. In-house developed software was used for the pixel-by-pixel flow velocity and shear stress measurements and the measurements were compared with physically measured mean velocity and shear stress. A comparison between the use of the in-house velocimetry software and a commercial velocimetry system was also performed. Curved steady flow models were scanned by phase-contrast MRI. Subsequently, velocity and shear stress were measured to confirm the shifted peak flow velocity and shear stress toward the outer side of the lumen. Peak velocity and shear stress were calculated for both the inner and outer half of the lumen and were statistically compared. The mean velocity measured with the use of in-house software had a significant correlation with the physical measurements of mean velocity; in addition, the measurement was more precise compared to the commercial system (R(2) = 0.85 vs. 0.75, respectively). The calculated mean shear stress had a significant correlation with the physical measurements of mean shear stress (R(2) = 0.95). The curved flow model showed a significantly shifted peak velocity and shear stress zones toward the outside of the flow (P < 0.0001). The technique to measure pixel-by-pixel velocity and shear stress of steady flow from velocity-encoded phase-contrast MRI was optimized. This technique had a good correlation with physical measurements and was superior to a commercially available system.
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Marín Rodríguez C, Alvaro EM, Sánchez Alegre ML, Martín YR, Carrasco JD. [Contrast-enhanced magnetic resonance angiography in congenital heart disease]. RADIOLOGIA 2009; 51:261-72. [PMID: 19457522 DOI: 10.1016/j.rx.2009.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 02/19/2009] [Indexed: 11/26/2022]
Abstract
Contrast-enhanced MR angiography is one of the greatest achievements brought about by advances in body MRI. The noninvasive evaluation of arteries and veins can obviate heart catheterization, the administration of iodinated contrast, and exposure to ionizing radiation in many patients and spare them the risks associated with these factors. These gains are even more important in children with congenital heart disease, who will have to undergo numerous vascular studies in their lifetimes and are more susceptible to the effects of ionizing radiation. Contrast-enhanced MR angiography provides abundant information for diagnosis and postoperative follow-up in these patients, who reach advanced age thanks to advances in medical and surgical treatment and thus receive more and more imaging studies during their lifetimes. In this review, we analyze the contrast-enhanced MR angiography technique in these patients, the problems and precautions related to the use of gadolinium, the indications for the test, and the relevant imaging findings in patients with congenital heart disease.
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Affiliation(s)
- C Marín Rodríguez
- Sección de Radiología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España.
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