Mitral Valve Flow and Myocardial Motion Assessed with Dual-Echo Dual-Velocity Cardiac MRI

Impact of the evaluation method on 4D flow-derived diastolic transmitral and myocardial peak velocities: Comparison with echocardiography

PURPOSE

To compare agreement of different evaluation methods of magnetic resonance (MR) 4D flow-derived diastolic transmitral and myocardial peak velocities as well as their ratios, using echocardiography as reference.

METHODS

In this prospective study, 60 subjects without symptoms of cardiovascular disease underwent echocardiography and non-contrast 3 T MR 4D flow imaging of the heart. Early- (E) and late-diastolic (A) transmitral peak filling velocities were evaluated from 4D flow data using three different strategies: 1) at the mitral valve tips in short-axis orientation (SA-method), 2) between the mitral valve tips in 4-chamber orientation (4-chamber-method), and 3) as maximal velocities in the transmitral inflow volume (max-velocity-method). Septal, lateral and average early-diastolic myocardial peak velocities (e') were derived from the myocardial tissue in the vicinity of the mitral valve. 4D flow parameters were compared with echocardiography by correlation and Bland-Altman analysis.

RESULTS

All 4D flow-derived E, A and E/A values correlated with echocardiography (r = 0.65-0.73, 0.75-0.83 and 0.74-0.86, respectively). While the SA- and 4-chamber-methods substantially underestimated E and A compared to echocardiography (p < 0.001), the max-velocity-method provided E (p = 0.13) and E/A (p = 0.07) without significant bias. Septal, lateral and average e' from 4D flow as well as the max-velocity-method-derived E/e' correlated with echocardiographic measurements (r = 0.64-0.81) and showed no significant bias (p = 0.26-0.54).

CONCLUSION

MR 4D flow imaging allows precise and accurate evaluation of transmitral and myocardial peak velocities for characterization of LV diastolic function without significant bias to echocardiography, when transmitral velocities are assessed from the transmitral inflow volume. This enables the use of validated echocardiography threshold values.

A phantom study comparing radial trajectories for accelerated cardiac 4D flow MRI against a particle imaging velocimetry reference

PURPOSE

Radial sampling is one method to accelerate 4D flow MRI acquisition, making feasible dual-velocity encoding (Venc) assessment of slow flow in the left ventricle (LV). Here, two radial trajectories are compared in vitro for this application: 3D radial (phase-contrast vastly undersampled isotropic projection, PC-VIPR) versus stack of stars (phase-contrast stack of stars, PC-SOS), with benchtop particle imaging velocimetry (PIV) serving as a reference standard.

METHODS

The study contained three steps: (1) Construction of an MRI- and PIV-compatible LV model from a healthy adult's CT images. (2) In vitro PIV using a pulsatile flow pump. (3) In vitro dual-Venc 4D flow MRI using PC-VIPR and PC-SOS (two repeat experiments). Each MR image set was retrospectively undersampled to five effective scan durations and compared with the PIV reference. The root-mean-square velocity vector difference (RMSE) between MRI and PIV images was compared, along with kinetic energy (KE) and wall shear stress (WSS).

RESULTS

RMSE increased as scan time decreased for both MR acquisitions. RMSE was 3% lower in PC-SOS images than PC-VIPR images in 30-min scans (3.8 vs. 3.9 cm/s) but 98% higher in 2.5-min scans (9.5 vs. 4.8 cm/s). PIV intrasession repeatability showed a RMSE of 4.4 cm/s, reflecting beat-to-beat flow variation, while MRI had intersession RMSEs of 3.8/3.5 cm/s for VIPR/SOS, respectively. Speed, KE, and WSS were overestimated voxel-wise in 30-min MRI scans relative to PIV by 0.4/0.3 cm/s, 0.2/0.1 μJ/mL, and 36/43 mPa, respectively, for VIPR/SOS.

CONCLUSIONS

PIV is feasible for application-specific 4D flow MRI protocol optimization. PC-VIPR is better-suited to dual-Venc LV imaging with short scan times.