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Parker L, Bollache E, Soulez S, Bouazizi K, Badenco N, Giese D, Gandjbakhch E, Redheuil A, Laredo M, Kachenoura N. A multi-modal computational fluid dynamics model of left atrial fibrillation haemodynamics validated with 4D flow MRI. Biomech Model Mechanobiol 2025; 24:139-152. [PMID: 39828784 DOI: 10.1007/s10237-024-01901-y] [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: 06/19/2024] [Accepted: 10/18/2024] [Indexed: 01/22/2025]
Abstract
Atrial fibrillation (AF) is characterized by rapid and irregular contraction of the left atrium (LA). Impacting LA haemodynamics, this increases the risk of thrombi development and stroke. Flow conditions preceding stroke in these patients are not well defined, partly due the limited resolution of 4D flow magnetic resonance imaging (MRI). In this study, we combine a high-resolution computed tomography (CT) LA reconstruction with motion and pulmonary inflows from 4D flow MRI to create a novel multimodal computational fluid dynamics (CFD) model, applying it to five AF patients imaged in sinus rhythm (24 ± 39 days between acquisitions). The dynamic model was compared with a rigid wall equivalent and the main flow structures were validated with 4D flow MRI. Point-by-point absolute differences between the velocity fields showed moderate differences given the sensitivity to registration. The rigid wall model significantly underestimated LA time-averaged wall shear stress (TAWSS) (p = 0.02) and oscillatory shear index (OSI) (p = 0.02) compared to the morphing model. Similarly, in the left atrial appendage (LAA), TAWSS (p = 0.003) and OSI (p < 0.001) were further underestimated. The morphing model yielded a more accurate mitral valve waveform and showed low TAWSS and high OSI in the LAA, both associated with thrombus formation. We also observed a positive correlation between indexed LA volume and endothelial cell activation potential (ECAP) (R2 = 0.83), as well as LAA volume and LAA OSI (R2 = 0.70). This work demonstrates the importance of LA motion in modelling LAA flow. Assessed in larger cohorts, LAA haemodynamic analysis may be beneficial to refine stroke risk assessment for AF.
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Affiliation(s)
- Louis Parker
- Laboratoire d'Imagerie Biomédicale (LIB), Institut National de La Recherche Médicale (INSERM), Centre National de La Recherche Scientifique (CNRS), Sorbonne Université, Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- School of Engineering, University of Western Australia, Perth, Australia
| | - Emilie Bollache
- Laboratoire d'Imagerie Biomédicale (LIB), Institut National de La Recherche Médicale (INSERM), Centre National de La Recherche Scientifique (CNRS), Sorbonne Université, Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Shannon Soulez
- Laboratoire d'Imagerie Biomédicale (LIB), Institut National de La Recherche Médicale (INSERM), Centre National de La Recherche Scientifique (CNRS), Sorbonne Université, Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Khaoula Bouazizi
- Laboratoire d'Imagerie Biomédicale (LIB), Institut National de La Recherche Médicale (INSERM), Centre National de La Recherche Scientifique (CNRS), Sorbonne Université, Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Nicolas Badenco
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Unité de Rythmologie, Institut de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthineers AG, Erlangen, Germany
| | - Estelle Gandjbakhch
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Unité de Rythmologie, Institut de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Alban Redheuil
- Laboratoire d'Imagerie Biomédicale (LIB), Institut National de La Recherche Médicale (INSERM), Centre National de La Recherche Scientifique (CNRS), Sorbonne Université, Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Unité d'Imagerie Cardiovasculaire Et Thoracique (ICT), Pitié-Salpêtrière Hospital, Paris, France
| | - Mikael Laredo
- Laboratoire d'Imagerie Biomédicale (LIB), Institut National de La Recherche Médicale (INSERM), Centre National de La Recherche Scientifique (CNRS), Sorbonne Université, Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Unité de Rythmologie, Institut de Cardiologie, Sorbonne Université, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale (LIB), Institut National de La Recherche Médicale (INSERM), Centre National de La Recherche Scientifique (CNRS), Sorbonne Université, Paris, France.
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
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Tajima S, Isoda H, Fukunaga M, Komori Y, Naganawa S, Sadato N. Verifying the Accuracy of Hemodynamic Analysis Using High Spatial Resolution 3D Phase-contrast MR Imaging on a 7T MR System: Comparison with a 3T System. Magn Reson Med Sci 2025; 24:88-102. [PMID: 38123345 PMCID: PMC11733508 DOI: 10.2463/mrms.mp.2023-0016] [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: 02/24/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Hemodynamics is important in the initiation, growth, and rupture of intracranial aneurysms. Since intracranial aneurysms are small, a high-field MR system with high spatial resolution and high SNR is desirable for this hemodynamic analysis. The purpose of this study was to investigate whether the accuracy of MR fluid dynamic (MRFD) results based on 3D phase-contrast MR (3D PC MR, non-electrocardiogram[ECG]-gated 4D Flow MRI) data from a human cerebrovascular phantom and human healthy subjects obtained by a 7T MR system was superior to those by a 3T MR system. METHODS 3D PC MR and 3D time of flight MR angiography (3D TOF MRA) imaging were performed on a 3T MR system and a 7T MR system for a human cerebrovascular phantom and 10 healthy human subjects, and MRFD analysis was performed using these data. The MRFD results from each MR system were then compared with the following items based on the computational fluid dynamics (CFD) results: 3D velocity vector field; correlation coefficient (R), angular similarity index (ASI), and magnitude similarity index (MSI) of blood flow velocity vectors. RESULTS In the MRFD results of 3D velocity vectors of the cerebrovascular phantom, noise-like vectors were observed near the vascular wall on the 3T MR system, but no noise was observed on the 7T MR system, showing results similar to those of CFD. In the MRFD results of the cerebrovascular phantom and healthy subjects, the correlation coefficients R, ASI, and MSI of the 7T MR system were higher than those of the 3T MR system, and ASI and MSI of healthy human subjects were significantly different between the two systems. CONCLUSIONS The accuracy of high spatial resolution MRFD using the 7T MR system exceeded that of the 3T MR system.
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Affiliation(s)
- Shunsuke Tajima
- Radiological Sciences, Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Haruo Isoda
- Brain & Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaki Fukunaga
- Division of Cerebral Integration, National Institute for Physiological Sciences, Okazaki, Aichi, Japan
| | | | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Norihiro Sadato
- Division of Cerebral Integration, National Institute for Physiological Sciences, Okazaki, Aichi, Japan
- Research Organization of Science and Technology, Ritsumeikan University, Kyoto, Kyoto, Japan
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Fischer K, Grob L, Setz L, Jung B, Neuenschwander MD, Utz CD, von Tengg-Kobligk H, Huber AT, Friess JO, Guensch DP. Direct comparison of whole heart quantifications between different retrospective and prospective gated 4D flow CMR acquisitions. Front Cardiovasc Med 2024; 11:1411752. [PMID: 39145279 PMCID: PMC11322094 DOI: 10.3389/fcvm.2024.1411752] [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: 04/03/2024] [Accepted: 07/18/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction 4D flow cardiovascular magnetic resonance (CMR) is a versatile technique to non-invasively assess cardiovascular hemodynamics. With developing technology, choice in sequences and acquisition parameters is expanding and it is important to assess if data acquired with these different variants can be directly compared, especially when combining datasets within research studies. For example, sequences may allow a choice in gating techniques or be limited to one method, yet there is not a direct comparison investigating how gating selection impacts quantifications of the great vessels, semilunar and atrioventricular valves and ventricles. Thus, this study investigated if quantifications across the heart from contemporary 4D flow sequences are comparable between two commonly used 4D flow sequences reliant on different ECG gating techniques. Methods Forty participants (33 healthy controls, seven patients with coronary artery disease and abnormal diastolic function) were prospectively recruited into a single-centre observational study to undergo a 3T-CMR exam. Two acquisitions, a k-t GRAPPA 4D flow with prospective gating (4Dprosp) and a modern compressed sensing 4D flow with retrospective gating (4Dretro), were acquired in each participant. Images were analyzed for volumes, flow rates and velocities in the vessels and four valves, and for biventricular kinetic energy and flow components. Data was compared for group differences with paired t-tests and for agreement with Bland-Altman and intraclass correlation (ICC). Results Measurements primarily occurring during systole of the great vessels, semilunar valves and both left and right ventricles did not differ between acquisition types (p > 0.05 from t-test) and yielded good to excellent agreement (ICC: 0.75-0.99). Similar findings were observed for the majority of parameters dependent on early diastole. However, measurements occurring in late diastole or those reliant on the entire-cardiac cycle such as flow component volumes along with diastolic kinetic energy values were not similar between 4Dprosp and 4Dretro acquisitions resulting in poor agreement (ICC < 0.50). Discussion Direct comparison of measurements between two different 4D flow acquisitions reliant on different gating methods demonstrated systolic and early diastolic markers across the heart should be compatible when comparing these two 4D flow sequences. On the other hand, late diastolic and intraventricular parameters should be compared with caution.
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Affiliation(s)
- Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leonard Grob
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Louis Setz
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Sitem-Insel, Bern, Switzerland
| | - Mario D. Neuenschwander
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph D. Utz
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Sitem-Insel, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Jan O. Friess
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik P. Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Faragli A, Hüllebrand M, Berendsen AJ, Solà LT, Lo Muzio FP, Götze C, Tanacli R, Doeblin P, Stehning C, Schnackenburg B, Van der Vosse FN, Nagel E, Post H, Hennemuth A, Alogna A, Kelle S. Pulmonary 4D-flow MRI imaging in landrace pigs under rest and stress. Int J Cardiovasc Imaging 2024; 40:1511-1524. [PMID: 38819601 PMCID: PMC11258182 DOI: 10.1007/s10554-024-03132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/04/2024] [Indexed: 06/01/2024]
Abstract
4D-flow MRI is a promising technique for assessing vessel hemodynamics. However, its utilization is currently limited by the lack of reference values, particularly for pulmonary vessels. In this work, we have analysed flow and velocity in the pulmonary trunk (PT), left and right pulmonary arteries (LPA and RPA, respectively) in Landrace pigs at both rest and stress through the software MEVISFlow. Nine healthy Landrace pigs were acutely instrumented closed-chest and transported to the CMR facility for evaluation. After rest measurements, dobutamine was administered to achieve a 25% increase in heart rate compared to rest. 4D-flow MRI images have been analysed through MEVISFlow by two independent observers. Inter- and intra-observer reproducibility was quantified using intraclass correlation coefficient. A significant difference between rest and stress regarding flow and velocity in all the pulmonary vessels was observed. Mean flow increased 55% in PT, 75% in LPA and 40% in RPA. Mean peak velocity increased 55% in PT, 75% in LPA and 66% in RPA. A good-to-excellent reproducibility was observed in rest and stress for flow measurements in all three arteries. An excellent reproducibility for velocity was found in PT at rest and stress, a good one for LPA and RPA at rest, while poor reproducibility was found at stress. The current study showed that pulmonary flow and velocity assessed through 4D-flow MRI follow the physiological alterations during cardiac cycle and after stress induced by dobutamine. A clinical translation to assess pulmonary diseases with 4D-flow MRI under stress conditions needs investigation.
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Affiliation(s)
- A Faragli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - M Hüllebrand
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Berlin, Germany
| | - A J Berendsen
- Department of Biomedical Engineering, Cardiovascular Biomechanics Group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - F P Lo Muzio
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - C Götze
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - R Tanacli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - P Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - C Stehning
- Clinical Science, Philips Healthcare, Hamburg, Germany
| | | | | | - E Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - H Post
- Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Mülheim, Germany
| | - A Hennemuth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Berlin, Germany
| | - A Alogna
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany.
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Wang X, Pu J. Recent Advances in Cardiac Magnetic Resonance for Imaging of Acute Myocardial Infarction. SMALL METHODS 2024; 8:e2301170. [PMID: 37992241 DOI: 10.1002/smtd.202301170] [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: 08/31/2023] [Revised: 10/14/2023] [Indexed: 11/24/2023]
Abstract
Acute myocardial infarction (AMI) is one of the primary causes of death worldwide, with a high incidence and mortality rate. Assessment of the infarcted and surviving myocardium, along with microvascular obstruction, is crucial for risk stratification, treatment, and prognosis in patients with AMI. Nonionizing radiation, excellent soft tissue contrast resolution, a large field of view, and multiplane imaging make cardiac magnetic resonance (CMR) a "one-stop" method for assessing cardiac structure, function, perfusion, and metabolism. Hence, this imaging technology is considered the "gold standard" for evaluating myocardial function and viability in AMI. This review critically compares the advantages and disadvantages of CMR with other cardiac imaging technologies, and relates the imaging findings to the underlying pathophysiological processes in AMI. A more thorough understanding of CMR technology will clarify their advanced clinical diagnosis and prognostic assessment applications, and assess the future approaches and challenges of CMR in the setting of AMI.
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Affiliation(s)
- Xu Wang
- Shanghai Jiao Tong University, School of Medicine Affiliated Renji Hospital, Shanghai, 200127, China
| | - Jun Pu
- Shanghai Jiao Tong University, School of Medicine Affiliated Renji Hospital, Shanghai, 200127, China
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Korte J, Klopp ES, Berg P. Multi-Dimensional Modeling of Cerebral Hemodynamics: A Systematic Review. Bioengineering (Basel) 2024; 11:72. [PMID: 38247949 PMCID: PMC10813503 DOI: 10.3390/bioengineering11010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
The Circle of Willis (CoW) describes the arterial system in the human brain enabling the neurovascular blood supply. Neurovascular diseases like intracranial aneurysms (IAs) can occur within the CoW and carry the risk of rupture, which can lead to subarachnoid hemorrhage. The assessment of hemodynamic information in these pathologies is crucial for their understanding regarding detection, diagnosis and treatment. Multi-dimensional in silico approaches exist to evaluate these hemodynamics based on patient-specific input data. The approaches comprise low-scale (zero-dimensional, one-dimensional) and high-scale (three-dimensional) models as well as multi-scale coupled models. The input data can be derived from medical imaging, numerical models, literature-based assumptions or from measurements within healthy subjects. Thus, the most realistic description of neurovascular hemodynamics is still controversial. Within this systematic review, first, the models of the three scales (0D, 1D, 3D) and second, the multi-scale models, which are coupled versions of the three scales, were discussed. Current best practices in describing neurovascular hemodynamics most realistically and their clinical applicablility were elucidated. The performance of 3D simulation entails high computational expenses, which could be reduced by analyzing solely the region of interest in detail. Medical imaging to establish patient-specific boundary conditions is usually rare, and thus, lower dimensional models provide a realistic mimicking of the surrounding hemodynamics. Multi-scale coupling, however, is computationally expensive as well, especially when taking all dimensions into account. In conclusion, the 0D-1D-3D multi-scale approach provides the most realistic outcome; nevertheless, it is least applicable. A 1D-3D multi-scale model can be considered regarding a beneficial trade-off between realistic results and applicable performance.
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Affiliation(s)
- Jana Korte
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, 39106 Magdeburg, Germany
| | - Ehlar Sophie Klopp
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
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Zimmermann J, Bäumler K, Loecher M, Cork TE, Marsden AL, Ennis DB, Fleischmann D. Hemodynamic effects of entry and exit tear size in aortic dissection evaluated with in vitro magnetic resonance imaging and fluid-structure interaction simulation. Sci Rep 2023; 13:22557. [PMID: 38110526 PMCID: PMC10728172 DOI: 10.1038/s41598-023-49942-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
Understanding the complex interplay between morphologic and hemodynamic features in aortic dissection is critical for risk stratification and for the development of individualized therapy. This work evaluates the effects of entry and exit tear size on the hemodynamics in type B aortic dissection by comparing fluid-structure interaction (FSI) simulations with in vitro 4D-flow magnetic resonance imaging (MRI). A baseline patient-specific 3D-printed model and two variants with modified tear size (smaller entry tear, smaller exit tear) were embedded into a flow- and pressure-controlled setup to perform MRI as well as 12-point catheter-based pressure measurements. The same models defined the wall and fluid domains for FSI simulations, for which boundary conditions were matched with measured data. Results showed exceptionally well matched complex flow patterns between 4D-flow MRI and FSI simulations. Compared to the baseline model, false lumen flow volume decreased with either a smaller entry tear (- 17.8 and - 18.5%, for FSI simulation and 4D-flow MRI, respectively) or smaller exit tear (- 16.0 and - 17.3%). True to false lumen pressure difference (initially 11.0 and 7.9 mmHg, for FSI simulation and catheter-based pressure measurements, respectively) increased with a smaller entry tear (28.9 and 14.6 mmHg), and became negative with a smaller exit tear (- 20.6 and - 13.2 mmHg). This work establishes quantitative and qualitative effects of entry or exit tear size on hemodynamics in aortic dissection, with particularly notable impact observed on FL pressurization. FSI simulations demonstrate acceptable qualitative and quantitative agreement with flow imaging, supporting its deployment in clinical studies.
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Affiliation(s)
| | - Kathrin Bäumler
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA, USA
- Division of Radiology, Veterans Affairs Health Care System, Palo Alto, CA, USA
| | - Tyler E Cork
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
- Division of Radiology, Veterans Affairs Health Care System, Palo Alto, CA, USA
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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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Jia D, Esmaily M. A time-consistent stabilized finite element method for fluids with applications to hemodynamics. Sci Rep 2023; 13:19120. [PMID: 37926732 PMCID: PMC10625993 DOI: 10.1038/s41598-023-46316-4] [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: 04/10/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023] Open
Abstract
Several finite element methods for simulating incompressible flows rely on the streamline upwind Petrov-Galerkin stabilization (SUPG) term, which is weighted by [Formula: see text]. The conventional formulation of [Formula: see text] includes a constant that depends on the time step size, producing an overall method that becomes exceedingly less accurate as the time step size approaches zero. In practice, such method inconsistency introduces significant error in the solution, especially in cardiovascular simulations, where small time step sizes may be required to resolve multiple scales of the blood flow. To overcome this issue, we propose a consistent method that is based on a new definition of [Formula: see text]. This method, which can be easily implemented on top of an existing streamline upwind Petrov-Galerkin and pressure stabilizing Petrov-Galerkin method, involves the replacement of the time step size in [Formula: see text] with a physical time scale. This time scale is calculated in a simple operation once every time step for the entire computational domain from the ratio of the L2-norm of the acceleration and the velocity. The proposed method is compared against the conventional method using four cases: a steady pipe flow, a blood flow through vascular anatomy, an external flow over a square obstacle, and a fluid-structure interaction case involving an oscillatory flexible beam. These numerical experiments, which are performed using linear interpolation functions, show that the proposed formulation eliminates the inconsistency issue associated with the conventional formulation in all cases. While the proposed method is slightly more costly than the conventional method, it significantly reduces the error, particularly at small time step sizes. For the pipe flow where an exact solution is available, we show the conventional method can over-predict the pressure drop by a factor of three. This large error is almost completely eliminated by the proposed formulation, dropping to approximately 1% for all time step sizes and Reynolds numbers considered.
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Affiliation(s)
- Dongjie Jia
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14850, USA
| | - Mahdi Esmaily
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14850, USA.
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10
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Löcke M, Garay Labra JE, Franco P, Uribe S, Bertoglio C. A comparison of phase unwrapping methods in velocity-encoded MRI for aortic flows. Magn Reson Med 2023; 90:2102-2115. [PMID: 37345719 DOI: 10.1002/mrm.29767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/17/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE The phase of a MRI signal is used to encode the velocity of blood flow. Phase unwrapping artifacts may appear when aiming to improve the velocity-to-noise ratio (VNR) of the measured velocity field. This study aims to compare various unwrapping algorithms on ground-truth synthetic data generated using computational fluid dynamics (CFD) simulations. METHODS We compare four different phase unwrapping algorithms on two different synthetic datasets of four-dimensional flow MRI and 26 datasets of 2D PC-MRI acquisitions including the ascending and descending aorta. The synthetic datasets are constructed using CFD simulations of an aorta with a coarctation, with different levels of spatiotemporal resolutions and noise. The error of the unwrapped images was assessed by comparison against the ground truth velocity field in the synthetic data and dual-VENC reconstructions in the in vivo data. RESULTS Using the unwrapping algorithms, we were able to remove aliased voxels in the data almost entirely, reducing the L2-error compared to the ground truth by 50%-80%. Results indicated that the best choice of algorithm depend on the spatiotemporal resolution and noise level of the dataset. Temporal unwrapping is most successful with a high temporal and low spatial resolution (δ t = 30 $$ \delta t=30 $$ ms,h = 2 . 5 $$ h=2.5 $$ mm), reducing the L2-error by 70%-85%, while Laplacian unwrapping performs better with a lower temporal or better spatial resolution (δ t = 60 $$ \delta t=60 $$ ms,h = 1 . 5 $$ h=1.5 $$ mm), especially for signal-to-noise ratio (SNR) 12 as opposed to SNR 15, with an error reduction of 55%-85% compared to the 50%-75% achieved by the Temporal method. The differences in performance between the methods are statistically significant. CONCLUSIONS The temporal method and spatiotemporal Laplacian method provide the best results, with the spatiotemporal Laplacian being more robust. However, single-V enc $$ {V}_{\mathrm{enc}} $$ methods only situationally and not generally reach the performance of dual-V enc $$ {V}_{\mathrm{enc}} $$ unwrapping methods.
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Affiliation(s)
- Miriam Löcke
- Bernoulli Institute, University of Groningen, Groningen, Groningen, The Netherlands
| | | | - Pamela Franco
- Biomedical Imaging Center, School of Engineering, Universidad Católica de Chile, Santiago, Región Metropolitana de Santiago, Chile
| | - Sergio Uribe
- Biomedical Imaging Center, School of Engineering, Universidad Católica de Chile, Santiago, Región Metropolitana de Santiago, Chile
| | - Cristóbal Bertoglio
- Bernoulli Institute, University of Groningen, Groningen, Groningen, The Netherlands
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11
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Kaiser AD, Schiavone NK, Elkins CJ, McElhinney DB, Eaton JK, Marsden AL. Comparison of Immersed Boundary Simulations of Heart Valve Hemodynamics Against In Vitro 4D Flow MRI Data. Ann Biomed Eng 2023; 51:2267-2288. [PMID: 37378877 PMCID: PMC10775908 DOI: 10.1007/s10439-023-03266-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
The immersed boundary (IB) method is a mathematical framework for fluid-structure interaction problems (FSI) that was originally developed to simulate flows around heart valves. Direct comparison of FSI simulations around heart valves against experimental data is challenging, however, due to the difficulty of performing robust and effective simulations, the complications of modeling a specific physical experiment, and the need to acquire experimental data that is directly comparable to simulation data. Such comparators are a necessary precursor for further formal validation studies of FSI simulations involving heart valves. In this work, we performed physical experiments of flow through a pulmonary valve in an in vitro pulse duplicator, and measured the corresponding velocity field using 4D flow MRI (4-dimensional flow magnetic resonance imaging). We constructed a computer model of this pulmonary artery setup, including modeling valve geometry and material properties via a technique called design-based elasticity, and simulated flow through it with the IB method. The simulated flow fields showed excellent qualitative agreement with experiments, excellent agreement on integral metrics, and reasonable relative error in the entire flow domain and on slices of interest. These results illustrate how to construct a computational model of a physical experiment for use as a comparator.
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Affiliation(s)
- Alexander D Kaiser
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Nicole K Schiavone
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | | | - Doff B McElhinney
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - John K Eaton
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Alison L Marsden
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford, CA, USA.
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA.
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
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12
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Wieben O, Roberts GS, Corrado PA, Johnson KM, Roldán-Alzate A. Four-Dimensional Flow MR Imaging: Technique and Advances. Magn Reson Imaging Clin N Am 2023; 31:433-449. [PMID: 37414470 DOI: 10.1016/j.mric.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
4D Flow MRI is an advanced imaging technique for comprehensive non-invasive assessment of the cardiovascular system. The capture of the blood velocity vector field throughout the cardiac cycle enables measures of flow, pulse wave velocity, kinetic energy, wall shear stress, and more. Advances in hardware, MRI data acquisition and reconstruction methodology allow for clinically feasible scan times. The availability of 4D Flow analysis packages allows for more widespread use in research and the clinic and will facilitate much needed multi-center, multi-vendor studies in order to establish consistency across scanner platforms and to enable larger scale studies to demonstrate clinical value.
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Affiliation(s)
- Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA.
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705-2275, USA
| | - Philip A Corrado
- Accuray Incorporated, 1414 Raleigh Road, Suite 330, DurhamChapel Hill, NC 27517, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Room: 3035, 1513 University Avenue, Madison, WI 53706, USA; Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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13
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An analysis of reconstruction noise from undersampled 4D flow MRI. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Yamanaka Y, Sano M, Katahashi K, Inuzuka K, Takehara Y, Ojima T, Takeuchi H, Unno N. Pre-Operative Four Dimensional Flow Sensitive Magnetic Resonance Imaging Assessment of Aortic Side Branches as a Method to Predict Risk of Type II Endoleak Resulting in Sac Enlargement After EVAR. Eur J Vasc Endovasc Surg 2023; 66:17-26. [PMID: 36736616 DOI: 10.1016/j.ejvs.2023.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/12/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To predict sac enlargement with type II endoleak (ELII) before endovascular aneurysm repair (EVAR) using four dimensional flow sensitive magnetic resonance imaging (4D flow MRI). METHODS A single centre retrospective analysis of prospectively collected data was conducted. Patients with an abdominal aortic aneurysm (AAA) who underwent EVAR between 2013 and 2019 were included. Aortic branches occluded pre-EVAR, and patients with endoleaks other than ELII were excluded. The aortic branch diameter, peak flow velocity (PFVe), and amplitude of the dynamics of flow volume (AFV) were measured in each aortic branch pre-EVAR. Total flow volume per minute (TFV/min), defined as the sum of AFV/min, was calculated in each case. According to computed tomography findings one year post-EVAR, the aortic branches and patients were divided into patent vessel and occluded vessel groups and sac expanding and non-expanding groups. PFVe, AFV/min, and TFV/min were analysed via receiver operating characteristic curve analysis. RESULTS The patent aortic branches pre-EVAR (69 inferior mesenteric arteries [IMAs]; 249 lumbar arteries [LAs]) of 100 patients were included. Patent IMAs (n = 14) and occluded IMAs (n = 55), patent LAs (n = 23) and occluded LAs (n = 226), and expanding (n = 9) and non-expanding (n = 91) groups were compared, respectively. No statistically significant difference was observed in branch diameters (IMA; patent, 2.5 ± 0.8 mm, occluded, 2.5 ± 0.8 mm, p < .78 and LA; patent, 1.5 ± 0.3 mm, occluded, 1.5 ± 0.4 mm, p < .35). PFVe (IMA; patent, 262.6 mm2/sec, occluded, 183.4 mm2/sec and LA; patent, 142.6 mm2/sec, occluded, 47.7 mm2/sec) and AFV/min (IMA; patent, 8.4 mL, occluded, 5.2 mL and LA; patent, 4.2 mL, occluded, 1.4 mL) were higher in the patent vessel group (p < .050). TFV/min was statistically significantly higher in the expanding group (24.1 mL/min) than in the non-expanding group (7.0 mL/min) (p < .010). CONCLUSION Pre-EVAR haemodynamic analyses using 4D flow MRI were useful to detect aortic branches responsible for ELII and to predict AAA cases with sac enlargement. This analysis suggests a new strategy for pre-EVAR aortic branch embolisation.
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Affiliation(s)
- Yuta Yamanaka
- Department of Surgery, Hamamatsu University School of Medicine, Japan; Division of Vascular Surgery, Hamamatsu University School of Medicine, Japan
| | - Masaki Sano
- Department of Surgery, Hamamatsu University School of Medicine, Japan; Division of Vascular Surgery, Hamamatsu University School of Medicine, Japan.
| | - Kazuto Katahashi
- Department of Surgery, Hamamatsu University School of Medicine, Japan; Division of Vascular Surgery, Hamamatsu University School of Medicine, Japan
| | - Kazunori Inuzuka
- Department of Surgery, Hamamatsu University School of Medicine, Japan; Division of Vascular Surgery, Hamamatsu University School of Medicine, Japan
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Japan
| | - Naoki Unno
- Department of Surgery, Hamamatsu University School of Medicine, Japan; Division of Vascular Surgery, Hamamatsu University School of Medicine, Japan; Department of Vascular Surgery, Hamamatsu Medical Centre, Japan
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15
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Falcão MBL, Rossi GMC, Rutz T, Prša M, Tenisch E, Ma L, Weiss EK, Baraboo JJ, Yerly J, Markl M, Stuber M, Roy CW. Focused navigation for respiratory-motion-corrected free-running radial 4D flow MRI. Magn Reson Med 2023; 90:117-132. [PMID: 36877140 PMCID: PMC10149606 DOI: 10.1002/mrm.29634] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To validate a respiratory motion correction method called focused navigation (fNAV) for free-running radial whole-heart 4D flow MRI. METHODS Using fNAV, respiratory signals derived from radial readouts are converted into three orthogonal displacements, which are then used to correct respiratory motion in 4D flow datasets. Hundred 4D flow acquisitions were simulated with non-rigid respiratory motion and used for validation. The difference between generated and fNAV displacement coefficients was calculated. Vessel area and flow measurements from 4D flow reconstructions with (fNAV) and without (uncorrected) motion correction were compared to the motion-free ground-truth. In 25 patients, the same measurements were compared between fNAV 4D flow, 2D flow, navigator-gated Cartesian 4D flow, and uncorrected 4D flow datasets. RESULTS For simulated data, the average difference between generated and fNAV displacement coefficients was 0.04± $$ \pm $$ 0.32 mm and 0.31± $$ \pm $$ 0.35 mm in the x and y directions, respectively. In the z direction, this difference was region-dependent (0.02± $$ \pm $$ 0.51 mm up to 5.85± $$ \pm $$ 3.41 mm). For all measurements (vessel area, net volume, and peak flow), the average difference from ground truth was higher for uncorrected 4D flow datasets (0.32± $$ \pm $$ 0.11 cm2 , 11.1± $$ \pm $$ 3.5 mL, and 22.3± $$ \pm $$ 6.0 mL/s) than for fNAV 4D flow datasets (0.10± $$ \pm $$ 0.03 cm2 , 2.6± $$ \pm $$ 0.7 mL, and 5.1± 0 $$ \pm 0 $$ .9 mL/s, p < 0.05). In vivo, average vessel area measurements were 4.92± $$ \pm $$ 2.95 cm2 , 5.06± $$ \pm $$ 2.64 cm2 , 4.87± $$ \pm $$ 2.57 cm2 , 4.87± $$ \pm $$ 2.69 cm2 , for 2D flow and fNAV, navigator-gated and uncorrected 4D flow datasets, respectively. In the ascending aorta, all 4D flow datasets except for the fNAV reconstruction had significantly different vessel area measurements from 2D flow. Overall, 2D flow datasets demonstrated the strongest correlation to fNAV 4D flow for both net volume (r2 = 0.92) and peak flow (r2 = 0.94), followed by navigator-gated 4D flow (r2 = 0.83 and r2 = 0.86, respectively), and uncorrected 4D flow (r2 = 0.69 and r2 = 0.86, respectively). CONCLUSION fNAV corrected respiratory motion in vitro and in vivo, resulting in fNAV 4D flow measurements that are comparable to those derived from 2D flow and navigator-gated Cartesian 4D flow datasets, with improvements over those from uncorrected 4D flow.
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Affiliation(s)
- Mariana B. L. Falcão
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Giulia M. C. Rossi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Tobias Rutz
- Service of Cardiology, Centre de Resonance Magnétique Cardiaque (CRMC), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Milan Prša
- Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Estelle Tenisch
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Liliana Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Elizabeth K. Weiss
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Justin J. Baraboo
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois USA
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Christopher W. Roy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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Righini P, Secchi F, Mazzaccaro D, Giese D, Galligani M, Avishay D, Capra D, Monti CB, Nano G. Four-Dimensional Flow MRI for the Evaluation of Aortic Endovascular Graft: A Pilot Study. Diagnostics (Basel) 2023; 13:2113. [PMID: 37371010 DOI: 10.3390/diagnostics13122113] [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: 04/27/2023] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
We aimed to explore the feasibility of 4D flow magnetic resonance imaging (MRI) for patients undergoing thoracic aorta endovascular repair (TEVAR). We retrospectively evaluated ten patients (two female), with a mean (±standard deviation) age of 61 ± 20 years, undergoing MRI for a follow-up after TEVAR. All 4D flow examinations were performed using a 1.5-T system (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany). In addition to the standard examination protocol, a 4D flow-sensitive 3D spatial-encoding, time-resolved, phase-contrast prototype sequence was acquired. Among our cases, flow evaluation was feasible in all patients, although we observed some artifacts in 3 out of 10 patients. Three individuals displayed a reduced signal within the vessel lumen where the endograft was placed, while others presented with turbulent or increased flow. An aortic endograft did not necessarily hinder the visualization of blood flow through 4D flow sequences, although the graft could generate flow artifacts in some cases. A 4D Flow MRI may represent the ideal tool to follow up on both healthy subjects deemed to be at an increased risk based on their anatomical characteristics or patients submitted to TEVAR for whom a surveillance protocol with computed tomography angiography would be cumbersome and unjustified.
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Affiliation(s)
- Paolo Righini
- Operative Unit of Vascular & Endovascular Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Daniela Mazzaccaro
- Operative Unit of Vascular & Endovascular Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, 91050 Erlangen, Germany
| | - Marina Galligani
- Operative Unit of Vascular & Endovascular Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Dor Avishay
- Operative Unit of Vascular & Endovascular Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Davide Capra
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Caterina Beatrice Monti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Giovanni Nano
- Operative Unit of Vascular & Endovascular Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy
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Sache A, Reymond P, Brina O, Jung B, Farhat M, Vargas MI. Near-wall hemodynamic parameters quantification in in vitro intracranial aneurysms with 7 T PC-MRI. MAGMA (NEW YORK, N.Y.) 2023; 36:295-308. [PMID: 37072539 PMCID: PMC10140017 DOI: 10.1007/s10334-023-01082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Wall shear stress (WSS) and its derived spatiotemporal parameters have proven to play a major role on intracranial aneurysms (IAs) growth and rupture. This study aims to demonstrate how ultra-high field (UHF) 7 T phase contrast magnetic resonance imaging (PC-MRI) coupled with advanced image acceleration techniques allows a highly resolved visualization of near-wall hemodynamic parameters patterns in in vitro IAs, paving the way for more robust risk assessment of their growth and rupture. MATERIALS AND METHODS We performed pulsatile flow measurements inside three in vitro models of patient-specific IAs using 7 T PC-MRI. To this end, we built an MRI-compatible test bench, which faithfully reproduced a typical physiological intracranial flow rate in the models. RESULTS The ultra-high field 7 T images revealed WSS patterns with high spatiotemporal resolution. Interestingly, the high oscillatory shear index values were found in the core of low WSS vortical structures and in flow stream intersecting regions. In contrast, maxima of WSS occurred around the impinging jet sites. CONCLUSIONS We showed that the elevated signal-to-noise ratio arising from 7 T PC-MRI enabled to resolve high and low WSS patterns with a high degree of detail.
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Affiliation(s)
- Antoine Sache
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Farhat
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Juffermans JF, Westenberg JJM, van den Boogaard PJ, Lamb HJ. Effects of ageing on aortic hemodynamics measured by 4D-flow MRI: a case series. Eur Heart J Case Rep 2023; 7:ytad130. [PMID: 37090762 PMCID: PMC10113929 DOI: 10.1093/ehjcr/ytad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/06/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
Background It has been demonstrated that the rate of aortic dilatation is influenced by alteration of aortic hemodynamics, such as normalized flow displacement (FDN) and wall shear stress (WSS). However, the effects of ageing on aortic hemodynamics have not yet been described. Case summary 4D-Flow MRI derived aorta hemodynamics were derived in the ascending aorta of a patient with ascending aortic aneurysm (mean ± standard deviation: 46 ± 1 mm) and a healthy volunteer (aortic diameter 30 ± 1 mm) with long-term follow-up of ten and eight years, respectively. At all timepoints, compared to the healthy volunteer, the patient demonstrated higher magnitudes of FDN (7% ± 1% vs. 3% ± 1%) and WSS angle (36° ± 3° vs. 24° ± 6°), and lower WSS magnitude (565 ± 100 mPa vs. 910 ± 115 mPa), axial WSS (426 ± 71 mPa vs. 800 ± 108 mPa) and circumferential WSS (297 ± 64 mPa vs. 340 ± 85 mPa). The patient and healthy volunteer demonstrated different aortic dilatation rates (regression slope ± standard error: 0.2 ± 0.1 vs. 0.1 ± 0.2 mm per year) and trends in FDN (0.1% ± 0.1% vs. 0.1% ± 0.2% per year), WSS magnitude (22 ± 9 vs. 35 ± 13 mPa per year), axial WSS (19 ± 4 vs. 37 ± 7 mPa per year), circumferential WSS (9 ± 8 vs. 5 ± 15 mPa per year), and WSS angle (-0.5° ± 0.4° vs. -0.8° ± 1.0° per year). Discussion Aortic hemodynamic parameters are marginally affected by ageing and the aortic diameter in this case series. Since aortic hemodynamic parameters have been associated with aortic dilation by previous studies, the outcomes of the two subjects suggest that the aortic dilatation rate will remain constant while individuals are ageing and dilating.
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Affiliation(s)
- Joe F Juffermans
- Corresponding author. Tel: +31 71 526 22 33, Fax: +31 71 524 82 56,
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Pieter J van den Boogaard
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Horiguchi R, Takehara Y, Sugiyama M, Hyodo R, Komada T, Matsushima M, Naganawa S, Mizuno T, Sakurai Y, Sugimoto M, Banno H, Komori K, Itatani K. Postendovascular Aneurysmal Repair Increase in Local Energy Loss for Fusiform Abdominal Aortic Aneurysm: Assessments With 4D flow MRI. J Magn Reson Imaging 2023; 57:1199-1211. [PMID: 35861188 DOI: 10.1002/jmri.28359] [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: 04/07/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although endovascular aneurysmal repair (EVAR) is a preferred treatment for abdominal aortic aneurysm (AAA) owing to its low invasiveness, its impact on the local hemodynamics has not been fully assessed. PURPOSE To elucidate how EVAR affects the local hemodynamics in terms of energy loss (EL). STUDY TYPE Prospective single-arm study. FIELD STRENGTH/SEQUENCE A 3.0 T/4D flow MRI using a phase-contrast three-dimensional cine-gradient-echo sequence. POPULATION A total of 13 consecutive patients (median [interquartile range] age: 77.0 [73.0, 78.8] years, 11 male) scheduled for EVAR as an initial treatment for fusiform AAA. ASSESSMENT 4D flow MRI covering the abdominal aorta and bilateral common iliac arteries and the corresponding stent-graft (SG) lumen was performed before and after EVAR. Plasma brain natriuretic peptide (BNP) was measured within 1 week before and 1 month after EVAR. The hemodynamic data, including mean velocity and the local EL, were compared pre-/post-EVAR. EL was correlated with AAA neck angle and with BNP. Patients were subdivided into deformed (N = 5) and undeformed SG subgroups (N = 8) and pre-/post-EVAR BNP compared in each. STATISTICS Parametric or nonparametric methods. Spearman's rank correlation coefficients (r). The interobserver/intraobserver variabilities with Bland-Altman plots. A P value < 0.05 is considered significant. RESULTS The mean velocity (cm/sec) at the AAA was five times greater after EVAR: 4.79 ± 0.32 vs. 0.91 ± 0.02. The total EL (mW) increased by 1.7 times after EVAR: 0.487 (0.420, 0.706) vs. 0.292 (0.192, 0.420). The total EL was proportional to the AAA neck angle pre-EVAR (r = 0.691) and post-EVAR (r = 0.718). BNP (pg/mL) was proportional to the total EL post-EVAR (r = 0.773). In the deformed SG group, EL (0.349 [0.261, 0.416]) increased 2.4-fold to 0.848 (0.597, 1.13), and the BNP 90.3 (53.6, 105) to 100 (67.2, 123) post-EVAR. CONCLUSION The local EL showed a 1.7-fold increase after EVAR. The larger increase in the EL in the deformed SG group might be a potential concern for frail patients. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ryota Horiguchi
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masataka Sugiyama
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomohiro Komada
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaya Matsushima
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Mizuno
- Department of Medical Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yasuo Sakurai
- Department of Medical Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Masayuki Sugimoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Osaka City University, Osaka, Japan
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20
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Deveshwar N, Rajagopal A, Sahin S, Shimron E, Larson PEZ. Synthesizing Complex-Valued Multicoil MRI Data from Magnitude-Only Images. Bioengineering (Basel) 2023; 10:358. [PMID: 36978749 PMCID: PMC10045391 DOI: 10.3390/bioengineering10030358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
Despite the proliferation of deep learning techniques for accelerated MRI acquisition and enhanced image reconstruction, the construction of large and diverse MRI datasets continues to pose a barrier to effective clinical translation of these technologies. One major challenge is in collecting the MRI raw data (required for image reconstruction) from clinical scanning, as only magnitude images are typically saved and used for clinical assessment and diagnosis. The image phase and multi-channel RF coil information are not retained when magnitude-only images are saved in clinical imaging archives. Additionally, preprocessing used for data in clinical imaging can lead to biased results. While several groups have begun concerted efforts to collect large amounts of MRI raw data, current databases are limited in the diversity of anatomy, pathology, annotations, and acquisition types they contain. To address this, we present a method for synthesizing realistic MR data from magnitude-only data, allowing for the use of diverse data from clinical imaging archives in advanced MRI reconstruction development. Our method uses a conditional GAN-based framework to generate synthetic phase images from input magnitude images. We then applied ESPIRiT to derive RF coil sensitivity maps from fully sampled real data to generate multi-coil data. The synthetic data generation method was evaluated by comparing image reconstruction results from training Variational Networks either with real data or synthetic data. We demonstrate that the Variational Network trained on synthetic MRI data from our method, consisting of GAN-derived synthetic phase and multi-coil information, outperformed Variational Networks trained on data with synthetic phase generated using current state-of-the-art methods. Additionally, we demonstrate that the Variational Networks trained with synthetic k-space data from our method perform comparably to image reconstruction networks trained on undersampled real k-space data.
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Affiliation(s)
- Nikhil Deveshwar
- UC Berkeley-UCSF Graduate Program in Bioengineering, Berkeley, CA 94701, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94701, USA
| | - Abhejit Rajagopal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Sule Sahin
- UC Berkeley-UCSF Graduate Program in Bioengineering, Berkeley, CA 94701, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
| | - Efrat Shimron
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94701, USA
| | - Peder E. Z. Larson
- UC Berkeley-UCSF Graduate Program in Bioengineering, Berkeley, CA 94701, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94016, USA
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21
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Sun X, Cheng LH, Plein S, Garg P, Moghari MH, van der Geest RJ. Deep learning-based prediction of intra-cardiac blood flow in long-axis cine magnetic resonance imaging. Int J Cardiovasc Imaging 2023; 39:1045-1053. [PMID: 36763209 PMCID: PMC10160163 DOI: 10.1007/s10554-023-02804-2] [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] [Received: 12/14/2022] [Accepted: 01/22/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE We aimed to design and evaluate a deep learning-based method to automatically predict the time-varying in-plane blood flow velocity within the cardiac cavities in long-axis cine MRI, validated against 4D flow. METHODS A convolutional neural network (CNN) was implemented, taking cine MRI as the input and the in-plane velocity derived from the 4D flow acquisition as the ground truth. The method was evaluated using velocity vector end-point error (EPE) and angle error. Additionally, the E/A ratio and diastolic function classification derived from the predicted velocities were compared to those derived from 4D flow. RESULTS For intra-cardiac pixels with a velocity > 5 cm/s, our method achieved an EPE of 8.65 cm/s and angle error of 41.27°. For pixels with a velocity > 25 cm/s, the angle error significantly degraded to 19.26°. Although the averaged blood flow velocity prediction was under-estimated by 26.69%, the high correlation (PCC = 0.95) of global time-varying velocity and the visual evaluation demonstrate a good agreement between our prediction and 4D flow data. The E/A ratio was derived with minimal bias, but with considerable mean absolute error of 0.39 and wide limits of agreement. The diastolic function classification showed a high accuracy of 86.9%. CONCLUSION Using a deep learning-based algorithm, intra-cardiac blood flow velocities can be predicted from long-axis cine MRI with high correlation with 4D flow derived velocities. Visualization of the derived velocities provides adjunct functional information and may potentially be used to derive the E/A ratio from conventional CMR exams.
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Affiliation(s)
- Xiaowu Sun
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Li-Hsin Cheng
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Mehdi H Moghari
- Department of Radiology, Children's Hospital Colorado, and School of Medicine, The University of Colorado, Boulder, CO, USA
| | - Rob J van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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22
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Ponnaluri SV, Hariharan P, Herbertson LH, Manning KB, Malinauskas RA, Craven BA. Results of the Interlaboratory Computational Fluid Dynamics Study of the FDA Benchmark Blood Pump. Ann Biomed Eng 2023; 51:253-269. [PMID: 36401112 DOI: 10.1007/s10439-022-03105-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022]
Abstract
Computational fluid dynamics (CFD) is widely used to simulate blood-contacting medical devices. To be relied upon to inform high-risk decision making, however, model credibility should be demonstrated through validation. To provide robust data sets for validation, researchers at the FDA and collaborators developed two benchmark medical device flow models: a nozzle and a centrifugal blood pump. Experimental measurements of the flow fields and hemolysis were acquired using each model. Concurrently, separate open interlaboratory CFD studies were performed in which participants from around the world, who were blinded to the measurements, submitted CFD predictions of each benchmark model. In this study, we report the results of the interlaboratory CFD study of the FDA benchmark blood pump. We analyze the results of 24 CFD submissions using a wide range of different flow solvers, methods, and modeling parameters. To assess the accuracy of the CFD predictions, we compare the results with experimental measurements of three quantities of interest (pressure head, velocity field, and hemolysis) at different pump operating conditions. We also investigate the influence of different CFD methods and modeling choices used by the participants. Our analyses reveal that, while a number of CFD submissions accurately predicted the pump performance for individual cases, no single participant was able to accurately predict all quantities of interest across all conditions. Several participants accurately predicted the pressure head at all conditions and the velocity field in all but one or two cases. Only one of the eight participants who submitted hemolysis results accurately predicted absolute plasma free hemoglobin levels at a majority of the conditions, though most participants were successful at predicting relative hemolysis levels between conditions. Overall, this study highlights the need to validate CFD modeling of rotary blood pumps across the entire range of operating conditions and for all quantities of interest, as some operating conditions and regions (e.g., the pump diffuser) are more challenging to accurately predict than others. All quantities of interest should be validated because, as shown here, it is possible to accurately predict hemolysis despite having relatively inaccurate predictions of the flow field.
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Affiliation(s)
- Sailahari V Ponnaluri
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA.,Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Prasanna Hariharan
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Luke H Herbertson
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA.,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Richard A Malinauskas
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Brent A Craven
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA.
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23
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Peper ES, van Ooij P, Jung B, Huber A, Gräni C, Bastiaansen JAM. Advances in machine learning applications for cardiovascular 4D flow MRI. Front Cardiovasc Med 2022; 9:1052068. [PMID: 36568555 PMCID: PMC9780299 DOI: 10.3389/fcvm.2022.1052068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Four-dimensional flow magnetic resonance imaging (MRI) has evolved as a non-invasive imaging technique to visualize and quantify blood flow in the heart and vessels. Hemodynamic parameters derived from 4D flow MRI, such as net flow and peak velocities, but also kinetic energy, turbulent kinetic energy, viscous energy loss, and wall shear stress have shown to be of diagnostic relevance for cardiovascular diseases. 4D flow MRI, however, has several limitations. Its long acquisition times and its limited spatio-temporal resolutions lead to inaccuracies in velocity measurements in small and low-flow vessels and near the vessel wall. Additionally, 4D flow MRI requires long post-processing times, since inaccuracies due to the measurement process need to be corrected for and parameter quantification requires 2D and 3D contour drawing. Several machine learning (ML) techniques have been proposed to overcome these limitations. Existing scan acceleration methods have been extended using ML for image reconstruction and ML based super-resolution methods have been used to assimilate high-resolution computational fluid dynamic simulations and 4D flow MRI, which leads to more realistic velocity results. ML efforts have also focused on the automation of other post-processing steps, by learning phase corrections and anti-aliasing. To automate contour drawing and 3D segmentation, networks such as the U-Net have been widely applied. This review summarizes the latest ML advances in 4D flow MRI with a focus on technical aspects and applications. It is divided into the current status of fast and accurate 4D flow MRI data generation, ML based post-processing tools for phase correction and vessel delineation and the statistical evaluation of blood flow.
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Affiliation(s)
- Eva S. Peper
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland,*Correspondence: Eva S. Peper,
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands,Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bernd Jung
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jessica A. M. Bastiaansen
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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24
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Kollar SE, Udine ML, Mandell JG, Cross RR, Loke YH, Olivieri LJ. Impact of ferumoxytol vs gadolinium on 4D flow cardiovascular magnetic resonance measurements in small children with congenital heart disease. J Cardiovasc Magn Reson 2022; 24:58. [PMID: 36352454 PMCID: PMC9648014 DOI: 10.1186/s12968-022-00886-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) allows for time-resolved three-dimensional phase-contrast (4D Flow) analysis of congenital heart disease (CHD). Higher spatial resolution in small infants requires thinner slices, which can degrade the signal. Particularly in infants, the choice of contrast agent (ferumoxytol vs. gadolinium) may influence 4D Flow CMR accuracy. Thus, we investigated the accuracy of 4D Flow CMR measurements compared to gold standard 2D flow phase contrast (PC) measurements in ferumoxytol vs. gadolinium-enhanced CMR of small CHD patients with shunt lesions. METHODS This was a retrospective study consisting of CMR studies from complex CHD patients less than 20 kg who had ferumoxytol or gadolinium-enhanced 4D Flow and standard two-dimensional phase contrast (2D-PC) flow collected. 4D Flow clinical software (Arterys) was used to measure flow in great vessels, systemic veins, and pulmonary veins. 4D Flow accuracy was defined as percent difference or correlation against conventional measurements (2D-PC) from the same vessels. Subgroup analysis was performed on two-ventricular vs single-ventricular CHD, arterial vs venous flow, as well as low flows (defined as < 1.5 L/min) in 1V CHD. RESULTS Twenty-one ferumoxytol-enhanced and 23 gadolinium-enhanced CMR studies were included, with no difference in age (2.1 ± 1.6 vs. 2.3 ± 1.9 years, p = 0.70), patient body surface area (0.50 ± 0.2 vs. 0.52 ± 0.2 m2, p = 0.67), or vessel diameter (11.4 ± 5.2 vs. 12.4 ± 5.6 mm, p = 0.22). Ten CMR studies with single ventricular CHD were included. Overall, ferumoxytol-enhanced 4D flow CMR measurements demonstrated less percent difference to 2D-PC when compared to gadolinium-enhanced 4D Flow CMR studies. In subgroup analyses of arterial vs. venous flows (high velocity vs. low velocity) and low flow in single ventricle CHD, ferumoxytol-enhanced 4D Flow CMR measurements had stronger correlation to 2D-PC CMR. The contrast-to-noise ratio (CNR) in ferumoxytol-enhanced studies was higher than the CNR in gadolinium-enhanced studies. CONCLUSIONS Ferumoxytol-enhanced 4D Flow CMR has improved accuracy when compared to gadolinium 4D Flow CMR, particularly for infants with small vessels in CHD.
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Affiliation(s)
- Sarah E Kollar
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA.
| | - Michelle L Udine
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Jason G Mandell
- Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Russell R Cross
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
| | - Laura J Olivieri
- Division of Pediatric Cardiology, Children's National Hospital, 111 Michigan Ave NW, WW 300, Suite 200, Washington, DC, 20010, USA
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25
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Mahinrad S, Tan CO, Ma Y, Aristova M, Milstead AL, Lloyd‐Jones D, Schnell S, Markl M, Sorond FA. Intracranial Blood Flow Quantification by Accelerated Dual-venc 4D Flow MRI: Comparison With Transcranial Doppler Ultrasound. J Magn Reson Imaging 2022; 56:1256-1264. [PMID: 35146822 PMCID: PMC9363520 DOI: 10.1002/jmri.28115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dual-venc 4D flow MRI, recently introduced for the assessment of intracranial hemodynamics, may provide a promising complementary approach to well-established tools such as transcranial Doppler ultrasound (TCD) and overcome some of their disadvantages. However, data comparing intracranial flow measures from dual-venc 4D flow MRI and TCD are lacking. PURPOSE To compare cerebral blood flow velocity measures derived from dual-venc 4D flow MRI and TCD. STUDY TYPE Prospective cohort. SUBJECTS A total of 25 healthy participants (56 ± 4 years old, 44% female). FIELD STRENGTH/SEQUENCE A 3 T/dual-venc 4D flow MRI using a time-resolved three-dimensional phase-contrast sequence with three-dimensional velocity encoding. ASSESSMENT Peak velocity measurements in bilateral middle cerebral arteries (MCA) were quantified from dual-venc 4D flow MRI and TCD. The MRI data were quantified by two independent observers (S.M and Y.M.) and TCD was performed by a trained technician (A.L.M.). We assessed the agreement between 4D flow MRI and TCD measures, and the interobserver agreement of 4D flow MRI measurements. STATISTICAL TESTS Peak velocity from MRI and TCD was compared using Bland-Altman analysis and coefficient of variance. Intraclass correlation coefficient (ICC) was used to assess MRI interobserver agreement. A P value < 0.05 was considered statistically significant. RESULTS There was excellent interobserver agreement in dual-venc 4D flow MRI-based measurements of peak velocity in bilateral MCA (ICC = 0.97 and 0.96 for the left and right MCA, respectively). Dual-venc 4D flow MRI significantly underestimated peak velocity in the left and right MCA compared to TCD (bias = 0.13 [0.59, -0.33] m/sec and 0.15 [0.47, -0.17] m/sec, respectively). The coefficient of variance between dual-venc 4D flow MRI and TCD measurements was 26% for the left MCA and 22% for the right MCA. DATA CONCLUSION There was excellent interobserver agreement for the assessment of MCA peak velocity using dual-venc 4D flow MRI, and ≤20% under-estimation compared with TCD. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Simin Mahinrad
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Can Ozan Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cerebrovascular Research LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
- Department of RadiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Yue Ma
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of RadiologyShengjing Hospital of China Medical UniversityChina
| | - Maria Aristova
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Andrew L. Milstead
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Donald Lloyd‐Jones
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Susanne Schnell
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Institute of Physics, Department of Medical PhysicsUniversity of GreifswaldGermany
| | - Michael Markl
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Farzaneh A. Sorond
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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26
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Hyodo R, Takehara Y, Naganawa S. 4D Flow MRI in the portal venous system: imaging and analysis methods, and clinical applications. Radiol Med 2022; 127:1181-1198. [PMID: 36123520 PMCID: PMC9587937 DOI: 10.1007/s11547-022-01553-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
Thus far, ultrasound, CT, and 2D cine phase-contrast MRI has been adopted to evaluate blood flow and vascular morphology in the portal venous system; however, all these techniques have some shortcomings, such as limited field of view and difficulty in accurately evaluating blood flow. A new imaging technique, namely 3D cine phase-contrast (4D Flow) MRI, can acquire blood flow data of the entire abdomen at once and in a time-resolved manner, allowing visual, quantitative, and comprehensive assessment of blood flow in the portal venous system. In addition, a retrospective blood flow analysis, i.e., "retrospective flowmetry," is possible. Although the development of 4D Flow MRI for the portal system has been delayed compared to that for the arterial system owing to the lower flow velocity of the portal venous system and the presence of respiratory artifacts, several useful reports have recently been published as the technology has advanced. In the first part of this narrative review article, technical considerations of image acquisition and analysis methods of 4D Flow MRI for the portal venous system and the validations of their results are described. In the second part, the current clinical application of 4D Flow MRI for the portal venous system is reviewed.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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27
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Kamada H, Nakamura M, Ota H, Higuchi S, Takase K. Blood flow analysis with computational fluid dynamics and 4D-flow MRI for vascular diseases. J Cardiol 2022; 80:386-396. [PMID: 35718672 DOI: 10.1016/j.jjcc.2022.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 10/31/2022]
Abstract
Both computational fluid dynamics (CFD) and time-resolved, three-dimensional, phase-contrast, magnetic resonance imaging (4D-flow MRI) enable visualization of time-varying blood flow structures and quantification of blood flow in vascular diseases. However, they are totally different. CFD is a method to calculate blood flow by solving the governing equations of fluid mechanics, so the obtained flow field is somewhat virtual. On the other hand, 4D-flow MRI measures blood flow in vivo, thus the flow is real. Recently, with the development and enhancement of computers, medical imaging techniques, and related software, blood flow analysis has become more accessible to clinicians and its usefulness in vascular diseases has been demonstrated. In this review, we have outlined the methods and characteristics of CFD and 4D-flow MRI, respectively. We have discussed the differences in the characteristics between both methods; reviewed the milestones achieved by blood flow analysis in various vascular diseases; and discussed the usefulness, challenges, and limitations of blood flow analysis. We have discussed the difficulties and limitations of current blood flow analysis. We have also discussed our views on future directions.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
| | - Masanori Nakamura
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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Impact of Respiratory Gating on Hemodynamic Parameters from 4D Flow MRI. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12062943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The hemodynamic parameters from 4D flow datasets have shown promising diagnostic value in different cardiovascular pathologies. However, the behavior of these parameters can be affected when the 4D flow data are corrupted by respiratory motion. The purpose of this work was to perform a quantitative comparison between hemodynamic parameters computed from 4D flow cardiac MRI both with and without respiratory self-gating. We considered 4D flow MRI data from 15 healthy volunteers (10 men and 5 women, 30.40 ± 6.23 years of age) that were acquired at 3T. Using a semiautomatic segmentation process of the aorta, we obtained the hemodynamic parameters from the 4D flow MRI, with and without respiratory self-gating. A statistical analysis, using the Wilcoxon signed-rank test and Bland–Altman, was performed to compare the hemodynamic parameters from both acquisitions. We found that the calculations of the hemodynamic parameters from 4D flow data that were acquired without respiratory self-gating showed underestimated values in the aortic arch, and the descending and diaphragmatic aorta. We also found a significant variability of the hemodynamic parameters in the ascending aorta of healthy volunteers when comparing both methods. The 4D flow MRI requires respiratory compensation to provide reliable calculations of hemodynamic parameters.
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Terada M, Takehara Y, Isoda H, Wakayama T, Nozaki A. Technical Background for 4D Flow MR Imaging. Magn Reson Med Sci 2022; 21:267-277. [PMID: 35153275 PMCID: PMC9680548 DOI: 10.2463/mrms.rev.2021-0104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/20/2021] [Indexed: 10/27/2023] Open
Abstract
Recently, the hemodynamic assessments with 3D cine phase-contrast (PC) MRI (4D flow MRI) have attracted considerable attention from clinicians. Unlike 2D cine PC MRI, the technique allows for cardiac phase-resolved data acquisitions of flow velocity vectors within the entire FOV during a clinically viable period. Thus, the method has enabled retrospective flowmetry in the spatial and temporal axes, which are essential to derive hemodynamic parameters related to vascular homeostasis and those to the progression of the pathologies. Accelerations in imaging are critical for this technology to be clinically viable; however, a high SNR or velocity-to-noise ratio (VNR) is also vital for accurate flow measurements. In this chapter, the technologies enabling this difficult balance are discussed.
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Affiliation(s)
- Masaki Terada
- Department of Diagnostic Radiologic Technology, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Haruo Isoda
- Department of Brain & Mind Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Atsushi Nozaki
- MR Applications and Workflow, GE Healthcare Japan, Tokyo, Japan
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30
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Sekine T, Nakaza M, Matsumoto M, Ando T, Inoue T, Sakamoto SI, Maruyama M, Obara M, Leonowicz O, Usuda J, Kumita S. 4D Flow MR Imaging of the Left Atrium: What is Non-physiological Blood Flow in the Cardiac System? Magn Reson Med Sci 2022; 21:293-308. [PMID: 35185085 PMCID: PMC9680542 DOI: 10.2463/mrms.rev.2021-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 01/30/2024] Open
Abstract
Most cardiac diseases cause a non-physiological blood flow pattern known as turbulence around the heart and great vessels, which further worsen the disease itself. However, there is no consensus on how blood flow can be defined in disease conditions. Especially, in the left atrium, the fact that vortex flow already exists makes this debate more complicated. 3D time-resolved phase-contrast (4D flow) MRI is expected to be able to capture blood flow patterns from multiple aspects, such as blood flow velocity, stasis, and vortex quantification. Previous studies have confirmed that physiological vortex flow is predominantly induced by the higher-volume flow from the superior left pulmonary vein. In atrial fibrillation, 4D flow MRI reveals a non-physiological blood flow pattern, which information may add value to well-established clinical risk factors. Currently, the research target of LA analysis has also widened to lung surgeons, pulmonary vein stump thrombosis after left upper lobectomy. 4D flow MRI is expected to be utilized for many more variable diseases that are currently unimaginable.
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Affiliation(s)
- Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Masatoki Nakaza
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Mitsuo Matsumoto
- Department of Thoracic Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School, Nagayama Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shun-Ichiro Sakamoto
- Department of Cardiovascular Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Mitsunori Maruyama
- Department of Cardiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | | | | | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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31
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Isoda H, Fukuyama A. Quality Control for 4D Flow MR Imaging. Magn Reson Med Sci 2022; 21:278-292. [PMID: 35197395 PMCID: PMC9680545 DOI: 10.2463/mrms.rev.2021-0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 01/06/2023] Open
Abstract
In recent years, 4D flow MRI has become increasingly important in clinical applications for the blood vessels in the whole body, heart, and cerebrospinal fluid. 4D flow MRI has advantages over 2D cine phase-contrast (PC) MRI in that any targeted area of interest can be analyzed post-hoc, but there are some factors to be considered, such as ensuring measurement accuracy, a long imaging time and post-processing complexity, and interobserver variability.Due to the partial volume phenomenon caused by low spatial and temporal resolutions, the accuracy of flow measurement in 4D flow MRI is reduced. For spatial resolution, it is recommended to include at least four voxels in the vessel of interest, and if possible, six voxels. In large vessels such as the aorta, large voxels can be secured and SNR can be maintained, but in small cerebral vessels, SNR is reduced, resulting in reduced accuracy. A temporal resolution of less than 40 ms is recommended. The velocity-to-noise ratio (VNR) of low-velocity blood flow is low, resulting in poor measurement accuracy. The use of dual velocity encoding (VENC) or multi-VENC is recommended to avoid velocity wrap around and to increase VNR. In order to maintain sufficient spatio-temporal resolution, a longer imaging time is required, leading to potential patient movement during examination and a corresponding decrease in measurement accuracy.For the clinical application of new technologies, including various acceleration techniques, in vitro and in vivo accuracy verification based on existing accuracy-validated 2D cine PC MRI and 4D flow MRI, as well as accuracy verification on the conservation of mass' principle, should be performed, and intraobserver repeatability, interobserver reproducibility, and test-retest reproducibility should be checked.
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Affiliation(s)
- Haruo Isoda
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Biomedical Imaging Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Atsushi Fukuyama
- Faculty of Health Sciences, Department of Radiological Sciences, Japan Healthcare University, Sapporo, Hokkaido, Japan
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Abstract
This special issue of Magnetic Resonance in Medical Sciences features the most recent reviews on 4D Flow MRI. These reviews deal with the current status of the emerging technique of 4D Flow MRI facilitated in various areas that are difficult to obtain with conventional flowmetry. MR signals inherently contain flow velocity information. In previous decades, in vivo blood flow measurement was traditionally performed by 2D methods, such as Doppler ultrasonography and 2D phase-contrast MRI, which have long been regarded as mature techniques in hemodynamic flowmetry. Although 2D velocimetries have many advantages over 4D Flow MRI in terms of cost and accessibility, and provide excellent temporal and in-plane spatial resolutions, they also have some disadvantages. The emerging technology of 4D Flow MRI can overcome the shortcomings of conventional 2D imaging. In recent years, hemodynamic analysis has witnessed significant progress that is primarily attributable to advances in 4D Flow MRI.
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Affiliation(s)
- Yasuo Takehara
- Department of Fundamental Development for Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Takayuki Obata
- Applied MRI Research, Department of Molecular Imaging and Theranostics, National Institutes for Quantum Science and Technology
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Sugiyama M, Takehara Y, Naganawa S. Does the Pulsatile Non-uniform Flow Matter in MR Flowmetry? Magn Reson Med Sci 2022; 21:365-371. [PMID: 35173117 DOI: 10.2463/mrms.rev.2021-0099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
3D cine phase-contrast (4D flow) MRI is a sequence with great potential for non-invasive time-resolved 3D flowmetry at arbitrary vessel sections in various blood vessels. However, it is not widely known that the flowmetry with 4D flow MRI is vulnerable to pulsatile and non-uniform flow. Due to the limited spatial and temporal resolutions, averaging within the 3D voxel is occurring during the flowmetry. A simple solution is to avoid setting the measurement plane in the area where non-uniform flow is dominant, which is possible with an aid of streamline depictions generated by computational fluid dynamics (CFD) or 4D flow MRI data. Unlike 4D flow MRI, flowmetry in CFD simulation can use higher spatial and temporal resolution depending on computer performance; therefore, it is robust to fluctuating non-uniform flow. However, the performance of CFD simulations might be limited due to inlet conditions with low temporal resolution. Difficulty applying complex blood flow such as reflection flow from periphery may also limit accurate simulation. Caution should be taken when comparing the result of CFD simulation to that of 4D flow measurement.
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Affiliation(s)
- Masataka Sugiyama
- Departments of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine.,Departments of Radiology, Nagoya University, Graduate School of Medicine
| | - Yasuo Takehara
- Departments of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine.,Departments of Radiology, Nagoya University, Graduate School of Medicine
| | - Shinji Naganawa
- Departments of Radiology, Nagoya University, Graduate School of Medicine
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Pravdivtseva MS, Gaidzik F, Berg P, Ulloa P, Larsen N, Jansen O, Hövener JB, Salehi Ravesh M. Influence of Spatial Resolution and Compressed SENSE Acceleration Factor on Flow Quantification with 4D Flow MRI at 3 Tesla. Tomography 2022; 8:457-478. [PMID: 35202203 PMCID: PMC8880336 DOI: 10.3390/tomography8010038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Four-dimensional (4D) flow MRI allows quantifying flow in blood vessels–non invasively and in vivo. The clinical use of 4D flow MRI in small vessels, however, is hampered by long examination times and limited spatial resolution. Compressed SENSE (CS-SENSE) is a technique that can accelerate 4D flow dramatically. Here, we investigated the effect of spatial resolution and CS acceleration on flow measurements by using 4D flow MRI in small vessels in vitro at 3 T. We compared the flow in silicon tubes (inner diameters of 2, 3, 4, and 5 mm) measured with 4D flow MRI, accelerated with four CS factors (CS = 2.5, 4.5, 6.5, and 13) and three voxel sizes (0.5, 1, and 1.5 mm3) to 2D flow MRI and a flow sensor. Additionally, the velocity field in an aneurysm model acquired with 4D flow MRI was compared to the one simulated with computational fluid dynamics (CFD). A strong correlation was observed between flow sensor, 2D flow MRI, and 4D flow MRI (rho > 0.94). The use of fewer than seven voxels per vessel diameter (nROI) resulted in an overestimation of flow in more than 5% of flow measured with 2D flow MRI. A negative correlation (rho = −0.81) between flow error and nROI were found for CS = 2.5 and 4.5. No statistically significant impact of CS factor on differences in flow rates was observed. However, a trend of increased flow error with increased CS factor was observed. In an aneurysm model, the peak velocity and stagnation zone were detected by CFD and all 4D flow MRI variants. The velocity difference error in the aneurysm sac did not exceed 11% for CS = 4.5 in comparison to CS = 2.5 for all spatial resolutions. Therefore, CS factors from 2.5–4.5 can appear suitable to improve spatial or temporal resolution for accurate quantification of flow rate and velocity. We encourage reporting the number of voxels per vessel diameter to standardize 4D flow MRI protocols.
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Affiliation(s)
- Mariya S. Pravdivtseva
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
- Correspondence: ; Tel.: +49-(0)-431-500-16-533
| | - Franziska Gaidzik
- Department of Fluid Dynamics and Technical Flows, Research Campus STIMULATE, Magdeburg University, 39106 Magdeburg, Germany; (F.G.); (P.B.)
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, Research Campus STIMULATE, Magdeburg University, 39106 Magdeburg, Germany; (F.G.); (P.B.)
| | - Patricia Ulloa
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, 24105 Kiel, Germany; (N.L.); (O.J.)
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, 24105 Kiel, Germany; (N.L.); (O.J.)
| | - Jan-Bernd Hövener
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
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35
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Ono A. [12. Noncontrast MR Angiography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1210-1216. [PMID: 36261357 DOI: 10.6009/jjrt.2022-2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Atsushi Ono
- Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare
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36
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Cvitkovic T, Bobylev D, Horke A, Avsar M, Beerbaum P, Martens A, Böthig D, Petenà E, Gutberlet M, Beyer FH, Wacker F, Cebotari S, Haverich A, Vogel-Claussen J, Sarikouch S, Czerner C. OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1307-1315. [PMID: 35079774 PMCID: PMC9154340 DOI: 10.1093/ejcts/ezac016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tomislav Cvitkovic
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Corresponding author. Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany. Tel: +49-511-532-9829; e-mail: (T. Cvitkovic)
| | - Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Böthig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elena Petenà
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frerk Hinnerk Beyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Czerner
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Lim SH, Mohd Adib MAH, Abdullah MS, Mohd Taib NH, Hassan R, Abd Aziz A. Investigate the Velocity Difference Between MRI Measurement and CFD Simulation on Patient-Specific Blood Flow Analysis. 6TH KUALA LUMPUR INTERNATIONAL CONFERENCE ON BIOMEDICAL ENGINEERING 2021 2022:453-460. [DOI: 10.1007/978-3-030-90724-2_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Hyodo R, Takehara Y, Mizuno T, Ichikawa K, Yokoyama S, Ishizu Y, Naganawa S. Assessing the Complicated Venous Hemodynamics and Therapeutic Outcomes of Budd-Chiari Syndrome with Respiratory-gated 4D Flow MR Imaging During the Expiratory and Inspiratory Phases. Magn Reson Med Sci 2021; 22:1-6. [PMID: 34880192 PMCID: PMC9849410 DOI: 10.2463/mrms.ici.2021-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A man in his 50s with Budd-Chiari syndrome diagnosed with the suprahepatic inferior vena cava (IVC) obstruction on CT was assessed using 4D Flow MRI before and after balloon angioplasty. 4D Flow MRI acquired in two respiratory phases, depicted complex hemodynamic and respiratory variability, and a jet stream at the narrowed channel of the membranous IVC. Post-interventional 4D Flow MRI showed that the IVC blood flow increased with corrected flow directions in the infrarenal IVC.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan,Corresponding author: Department of Radiology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. Phone: +81-52-744-2327, Fax: +81-52-744-2335, E-mail:
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan,Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Mizuno
- Department of Medical Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kazushige Ichikawa
- Department of Medical Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Nolte D, Urbina J, Sotelo J, Sok L, Montalba C, Valverde I, Osses A, Uribe S, Bertoglio C. Validation of 4D Flow based relative pressure maps in aortic flows. Med Image Anal 2021; 74:102195. [PMID: 34419837 DOI: 10.1016/j.media.2021.102195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/11/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
While the clinical gold standard for pressure difference measurements is invasive catheterization, 4D Flow MRI is a promising tool for enabling a non-invasive quantification, by linking highly spatially resolved velocity measurements with pressure differences via the incompressible Navier-Stokes equations. In this work we provide a validation and comparison with phantom and clinical patient data of pressure difference maps estimators. We compare the classical Pressure Poisson Estimator (PPE) and the new Stokes Estimator (STE) against catheter pressure measurements under a variety of stenosis severities and flow intensities. Specifically, we use several 4D Flow data sets of realistic aortic phantoms with different anatomic and hemodynamic severities and two patients with aortic coarctation. The phantom data sets are enriched by subsampling to lower resolutions, modification of the segmentation and addition of synthetic noise, in order to study the sensitivity of the pressure difference estimators to these factors. Overall, the STE method yields more accurate results than the PPE method compared to catheterization data. The superiority of the STE becomes more evident at increasing Reynolds numbers with a better capacity of capturing pressure gradients in strongly convective flow regimes. The results indicate an improved robustness of the STE method with respect to variation in lumen segmentation. However, with heuristic removal of the wall-voxels, the PPE can reach a comparable accuracy for lower Reynolds' numbers.
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Affiliation(s)
- David Nolte
- Bernoulli Institute, University of Groningen, Groningen, 9747AG, The Netherlands; Center for Mathematical Modeling, Universidad de Chile, Santiago, 8370456, Chile
| | - Jesús Urbina
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, 833002, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile
| | - Julio Sotelo
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile; School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile; Department of Electrical Engineering, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile
| | - Leo Sok
- Bernoulli Institute, University of Groningen, Groningen, 9747AG, The Netherlands
| | - Cristian Montalba
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile
| | - Israel Valverde
- Hospital Universitario Virgen del Rocío, Sevilla, 41013, Spain
| | - Axel Osses
- Center for Mathematical Modeling, Universidad de Chile, Santiago, 8370456, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, 833002, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile
| | - Cristóbal Bertoglio
- Bernoulli Institute, University of Groningen, Groningen, 9747AG, The Netherlands; Center for Mathematical Modeling, Universidad de Chile, Santiago, 8370456, Chile.
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40
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Tsukada T, Izumi T, Isoda H, Nishihori M, Kropp AE, Mizuno T, Wakabayashi T. Comparison of hemodynamic stress in healthy vessels after parent artery occlusion and flow diverter stent treatment for internal carotid artery aneurysm. J Neurosurg 2021; 136:619-626. [PMID: 34416714 DOI: 10.3171/2021.2.jns204185] [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: 12/04/2020] [Accepted: 02/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE De novo aneurysms generally develop in healthy vessels after parent artery occlusion for large internal carotid artery (ICA) aneurysm, possibly owing to increased hemodynamic stress in the remaining vessels. In recent years, there has been a shift toward flow diverter stent treatment. However, there is a lack of direct evidence and data that prove this change in hemodynamic stress in healthy vessels after parent artery occlusion and flow diverter stent treatment. The authors compared hemodynamic stress in healthy-side vessels before and after parent artery occlusion and flow diverter treatments. METHODS The authors included patients who underwent 3D cine phase-contrast MRI before and after large ICA aneurysm treatment. Spatially and temporally averaged volume flow rates and spatially averaged systolic wall shear stress (WSS) in healthy-side ICA distal to the posterior communicating artery (C1 segment according to Fisher's classification) were measured before and after parent artery occlusion and flow diverter treatments. RESULTS Seventeen patients were included (5 patients in the parent artery occlusion group and 12 in the flow diverter group). At 1-2 months after treatment, median volume flow rate in healthy-side ICA increased from 5.36 ml/sec to 6.28 ml/sec (total increase 117%, p = 0.04) in the parent artery occlusion group and from 4.65 ml/sec to 4.93 ml/sec (total increase 106%, p = 0.02) in the flow diverter group. In the parent artery occlusion group, median WSS in the C1 segment of the healthy-side ICA increased from 3.91 Pa to 5.61 Pa (total increase 143%, p = 0.08); however, no significant increase was observed in the flow diverter group (4.29 Pa to 4.57 Pa [total increase 107%, p = 0.21]). CONCLUSIONS Postoperatively, volume flow rate and WSS in the C1 segment of the healthy-side ICA significantly increased in the parent artery occlusion group. Therefore, the parent artery occlusion group was more prone to de novo aneurysm than the flow diverter group.
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Affiliation(s)
- Tetsuya Tsukada
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Izumi
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Haruo Isoda
- 2Brain & Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Masahiro Nishihori
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - A Elisabeth Kropp
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Mizuno
- 3Department of Medical Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Annio G, Torii R, Ducci A, Muthurangu V, Tsang V, Burriesci G. Experimental Validation of Enhanced Magnetic Resonance Imaging (EMRI) Using Particle Image Velocimetry (PIV). Ann Biomed Eng 2021; 49:3481-3493. [PMID: 34181130 DOI: 10.1007/s10439-021-02811-1] [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: 01/31/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
Flow-sensitive four-dimensional Cardiovascular Magnetic Resonance Imaging (4D Flow CMR) has increasingly been utilised to characterise patients' blood flow, in association with patiens' state of health and disease, even though spatial and temporal resolutions still constitute a limit. Computational fluid dynamics (CFD) is a powerful tool that could expand these information and, if integrated with experimentally-obtained velocity fields, would enable to derive a large variety of the flow descriptors of interest. However, the accuracy of the flow parameters is highly influenced by the quality of the input data such as the anatomical model and boundary conditions typically derived from medical images including 4D Flow CMR. We previously proposed a novel approach in which 4D Flow CMR and CFD velocity fields are integrated to obtain an Enhanced 4D Flow CMR (EMRI), allowing to overcome the spatial-resolution limitation of 4D Flow CMR, and enable an accurate quantification of flow. In this paper, the proposed approach is validated in a U bend channel, an idealised model of the human aortic arch. The flow patterns were studied with 4D Flow CMR, CFD and EMRI, and compared with high resolution 2D PIV experiments obtained in pulsatile conditions. The main strengths and limitations of 4D Flow CMR and CFD were illustrated by exploiting the accuracy of PIV by comparing against PIV velocity fields. EMRI flow patterns showed a better qualitative and quantitative agreement with PIV results than the other techniques. EMRI enables to overcome the experimental limitations of MRI-based velocity measurements and the modelling simplifications of CFD, allowing an accurate prediction of complex flow patterns observed experimentally, while satisfying mass and momentum balance equations.
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Affiliation(s)
- Giacomo Annio
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK.
| | - Andrea Ducci
- Department of Mechanical Engineering, University College London, London, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging and Physics, University College London, London, UK
| | - Victor Tsang
- Cardiothoracic Surgery Unit, Great Ormond Street Hospital, London, UK
| | - Gaetano Burriesci
- Department of Mechanical Engineering, University College London, London, UK.
- Ri.MED Foundation, Palermo, Italy.
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Demir A, Wiesemann S, Erley J, Schmitter S, Trauzeddel RF, Pieske B, Hansmann J, Kelle S, Schulz-Menger J. Traveling Volunteers: A Multi-Vendor, Multi-Center Study on Reproducibility and Comparability of 4D Flow Derived Aortic Hemodynamics in Cardiovascular Magnetic Resonance. J Magn Reson Imaging 2021; 55:211-222. [PMID: 34173297 DOI: 10.1002/jmri.27804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Implementation of four-dimensional flow magnetic resonance (4D Flow MR) in clinical routine requires awareness of confounders. PURPOSE To investigate inter-vendor comparability of 4D Flow MR derived aortic hemodynamic parameters, assess scan-rescan repeatability, and intra- and interobserver reproducibility. STUDY TYPE Prospective multicenter study. POPULATION Fifteen healthy volunteers (age 24.5 ± 5.3 years, 8 females). FIELD STRENGTH/SEQUENCE 3 T, vendor-provided and clinically used 4D Flow MR sequences of each site. ASSESSMENT Forward flow volume, peak velocity, average, and maximum wall shear stress (WSS) were assessed via nine planes (P1-P9) throughout the thoracic aorta by a single observer (AD, 2 years of experience). Inter-vendor comparability as well as scan-rescan, intra- and interobserver reproducibility were examined. STATISTICAL TESTS Equivalence was tested setting the 95% confidence interval of intraobserver and scan-rescan difference as the limit of clinical acceptable disagreement. Intraclass correlation coefficient (ICC) and Bland-Altman plots were used for scan-rescan reproducibility and intra- and interobserver agreement. A P-value <0.05 was considered statistically significant. ICCs ≥ 0.75 indicated strong correlation (>0.9: excellent, 0.75-0.9: good). RESULTS Ten volunteers finished the complete study successfully. 4D flow derived hemodynamic parameters between scanners of three different vendors are not equivalent exceeding the equivalence range. P3-P9 differed significantly between all three scanners for forward flow (59.1 ± 13.1 mL vs. 68.1 ± 12.0 mL vs. 55.4 ± 13.1 mL), maximum WSS (1842.0 ± 190.5 mPa vs. 1969.5 ± 398.7 mPa vs. 1500.6 ± 247.2 mPa), average WSS (1400.0 ± 149.3 mPa vs. 1322.6 ± 211.8 mPa vs. 1142.0 ± 198.5 mPa), and peak velocity between scanners I vs. III (114.7 ± 12.6 cm/s vs. 101.3 ± 15.6 cm/s). Overall, the plane location at the sinotubular junction (P1) presented most inter-vendor stability (forward: 78.5 ± 15.1 mL vs. 80.3 ± 15.4 mL vs. 79.5 ± 19.9 mL [P = 0.368]; peak: 126.4 ± 16.7 cm/s vs. 119.7 ± 13.6 cm/s vs. 111.2 ± 22.6 cm/s [P = 0.097]). Scan-rescan reproducibility and intra- and interobserver variability were good to excellent (ICC ≥ 0.8) with best agreement for forward flow (ICC ≥ 0.98). DATA CONCLUSION The clinical protocol used at three different sites led to differences in hemodynamic parameters assessed by 4D flow. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Aylin Demir
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Stephanie Wiesemann
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Ralf Felix Trauzeddel
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Burkert Pieske
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany
| | - Jochen Hansmann
- Department of Radiology, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany
| | - Sebastian Kelle
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité-Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Puiseux T, Sewonu A, Moreno R, Mendez S, Nicoud F. Numerical simulation of time-resolved 3D phase-contrast magnetic resonance imaging. PLoS One 2021; 16:e0248816. [PMID: 33770130 PMCID: PMC7997039 DOI: 10.1371/journal.pone.0248816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022] Open
Abstract
A numerical approach is presented to efficiently simulate time-resolved 3D phase-contrast Magnetic resonance Imaging (or 4D Flow MRI) acquisitions under realistic flow conditions. The Navier-Stokes and Bloch equations are simultaneously solved with an Eulerian-Lagrangian formalism. A semi-analytic solution for the Bloch equations as well as a periodic particle seeding strategy are developed to reduce the computational cost. The velocity reconstruction pipeline is first validated by considering a Poiseuille flow configuration. The 4D Flow MRI simulation procedure is then applied to the flow within an in vitro flow phantom typical of the cardiovascular system. The simulated MR velocity images compare favorably to both the flow computed by solving the Navier-Stokes equations and experimental 4D Flow MRI measurements. A practical application is finally presented in which the MRI simulation framework is used to identify the origins of the MRI measurement errors.
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Affiliation(s)
- Thomas Puiseux
- IMAG, University Montpellier, CNRS, Montpellier, France
- Spin Up, Strasbourg, France
- I2MC, INSERM UMR 1297, Toulouse, France
- * E-mail:
| | | | - Ramiro Moreno
- Spin Up, Strasbourg, France
- I2MC, INSERM UMR 1297, Toulouse, France
- ALARA Expertise, Strasbourg, France
| | - Simon Mendez
- IMAG, University Montpellier, CNRS, Montpellier, France
| | - Franck Nicoud
- IMAG, University Montpellier, CNRS, Montpellier, France
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On the impact of vessel wall stiffness on quantitative flow dynamics in a synthetic model of the thoracic aorta. Sci Rep 2021; 11:6703. [PMID: 33758315 PMCID: PMC7988183 DOI: 10.1038/s41598-021-86174-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Aortic wall stiffening is a predictive marker for morbidity in hypertensive patients. Arterial pulse wave velocity (PWV) correlates with the level of stiffness and can be derived using non-invasive 4D-flow magnetic resonance imaging (MRI). The objectives of this study were twofold: to develop subject-specific thoracic aorta models embedded into an MRI-compatible flow circuit operating under controlled physiological conditions; and to evaluate how a range of aortic wall stiffness impacts 4D-flow-based quantification of hemodynamics, particularly PWV. Three aorta models were 3D-printed using a novel photopolymer material at two compliant and one nearly rigid stiffnesses and characterized via tensile testing. Luminal pressure and 4D-flow MRI data were acquired for each model and cross-sectional net flow, peak velocities, and PWV were measured. In addition, the confounding effect of temporal resolution on all metrics was evaluated. Stiffer models resulted in increased systolic pressures (112, 116, and 133 mmHg), variations in velocity patterns, and increased peak velocities, peak flow rate, and PWV (5.8–7.3 m/s). Lower temporal resolution (20 ms down to 62.5 ms per image frame) impacted estimates of peak velocity and PWV (7.31 down to 4.77 m/s). Using compliant aorta models is essential to produce realistic flow dynamics and conditions that recapitulated in vivo hemodynamics.
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45
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Hyodo R, Takehara Y, Mizuno T, Ichikawa K, Ishizu Y, Sugiyama M, Naganawa S. Time-resolved 3D cine phase-contrast magnetic resonance imaging (4D-flow MRI) can quantitatively assess portosystemic shunt severity and confirm normalization of portal flow after embolization of large portosystemic shunts. Hepatol Res 2021; 51:343-349. [PMID: 33434371 DOI: 10.1111/hepr.13616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/20/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022]
Abstract
Diagnosis and severity assessments of portosystemic shunts (PSSs) are important because the pathology sometimes results in severe hepatic encephalopathy, which can be treated almost completely by shunt embolization. At present, morphological assessment of PSS is performed mainly by computed tomography, and ultrasound is used for blood flow assessment. In two cases of PSS-related hepatic encephalopathy, we used time-resolved 3D cine phase-contrast (4D-flow) magnetic resonance imaging (MRI) to assess blood flow before and after shunt embolization. Before the intervention, blood flow in the main trunk of the superior mesenteric vein was mostly hepatofugal. However, post-interventional 4D-flow MRI revealed hepatopetal superior mesenteric vein flow with significantly increased portal vein blood flow. 4D-flow MRI is an ideal adjunct to Doppler ultrasonography, allowing for objective and visual assessment of morphology and blood flow of the portal venous system, including PSSs, and is useful in determining the indications for, and outcome of, PSS embolization.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.,Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Takashi Mizuno
- Department of Medical Radiological Technology, Nagoya University Hospital, Showa-ku, Nagoya, Japan
| | - Kazushige Ichikawa
- Department of Medical Radiological Technology, Nagoya University Hospital, Showa-ku, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Masataka Sugiyama
- Department of Radiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.,Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
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46
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4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction. Int J Cardiovasc Imaging 2021; 37:2755-2765. [PMID: 33523363 DOI: 10.1007/s10554-021-02167-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆PMRI) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KELA) was computed throughout systole. Average systolic (KELA-avg) and peak systolic (KELA-peak) KELA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆PMRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KELA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KELA-avg (14.8 [10.6, 20.4] J/m3 vs. 33.4 [23.9, 61.3] J/m3, P < 0.001) and KELA-peak (22.1 [15.9, 28.7] J/m3 vs. 57.2 [44.5, 121.4] J/m3, P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KELA-avg (rho = 0.81, P < 0.001) and KELA-peak (rho = 0.79, P < 0.001). LVOT ∆PMRI was strongly correlated with KELA metrics in obstructive HCM (KELA-avg: rho = 0.86, P < 0.001; KELA-peak: rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction.
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47
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Morgan AG, Thrippleton MJ, Wardlaw JM, Marshall I. 4D flow MRI for non-invasive measurement of blood flow in the brain: A systematic review. J Cereb Blood Flow Metab 2021; 41:206-218. [PMID: 32936731 PMCID: PMC8369999 DOI: 10.1177/0271678x20952014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
The brain's vasculature is essential for brain health and its dysfunction contributes to the onset and development of many dementias and neurological disorders. While numerous in vivo imaging techniques exist to investigate cerebral haemodynamics in humans, phase-contrast magnetic resonance imaging (MRI) has emerged as a reliable, non-invasive method of quantifying blood flow within intracranial vessels. In recent years, an advanced form of this method, known as 4D flow, has been developed and utilised in patient studies, where its ability to capture complex blood flow dynamics within any major vessel across the acquired volume has proved effective in collecting large amounts of information in a single scan. While extremely promising as a method of examining the vascular system's role in brain-related diseases, the collection of 4D data can be time-consuming, meaning data quality has to be traded off against the acquisition time. Here, we review the available literature to examine 4D flow's capabilities in assessing physiological and pathological features of the cerebrovascular system. Emerging techniques such as dynamic velocity-encoding and advanced undersampling methods, combined with increasingly high-field MRI scanners, are likely to bring 4D flow to the forefront of cerebrovascular imaging studies in the years to come.
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Affiliation(s)
- Alasdair G Morgan
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
| | - Michael J Thrippleton
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology,
University of Edinburgh, Edinburgh, UK
| | - Ian Marshall
- Brain Research Imaging Centre, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at The University of Edinburgh,
Edinburgh Medical School, Edinburgh, UK
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48
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Intracardiac and Vascular Hemodynamics with Cardiovascular Magnetic Resonance in Heart Failure. Heart Fail Clin 2021; 17:135-147. [PMID: 33220882 DOI: 10.1016/j.hfc.2020.08.010] [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: 11/23/2022]
Abstract
In heart failure (HF), the impaired heart loses its ability to competently eject blood during systole or fill with blood during diastole, manifesting in multifaceted abnormal intracardiac or intravascular flow dynamics. Conventional imaging techniques are limited in their ability to evaluate multidirectional multidimensional flow alterations in HF. Four-dimensional (4-D) flow magnetic resonance imaging (MRI) has emerged as a promising technique to comprehensively visualize and quantify changes in 3-dimensional blood flow dynamics in complex cardiovascular diseases. This article reviews emerging applications of 4-D flow MRI hemodynamic markers in HF and etiologies at risk of progressing to HF.
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49
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Schiavone NK, Elkins CJ, McElhinney DB, Eaton JK, Marsden AL. In Vitro Assessment of Right Ventricular Outflow Tract Anatomy and Valve Orientation Effects on Bioprosthetic Pulmonary Valve Hemodynamics. Cardiovasc Eng Technol 2021; 12:215-231. [PMID: 33452649 DOI: 10.1007/s13239-020-00507-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 12/02/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE The congenital heart defect Tetralogy of Fallot (ToF) affects 1 in 2500 newborns annually in the US and typically requires surgical repair of the right ventricular outflow tract (RVOT) early in life, with variations in surgical technique leading to large disparities in RVOT anatomy among patients. Subsequently, often in adolescence or early adulthood, patients usually require surgical placement of a xenograft or allograft pulmonary valve prosthesis. Valve longevity is highly variable for reasons that remain poorly understood. METHODS This work aims to assess the performance of bioprosthetic pulmonary valves in vitro using two 3D printed geometries: an idealized case based on healthy subjects aged 11 to 13 years and a diseased case with a 150% dilation in vessel diameter downstream of the valve. Each geometry was studied with two valve orientations: one with a valve leaflet opening posterior, which is the native pulmonary valve position, and one with a valve leaflet opening anterior. RESULTS Full three-dimensional, three-component, phase-averaged velocity fields were obtained in the physiological models using 4D flow MRI. Flow features, particularly vortex formation and reversed flow regions, differed significantly between the RVOT geometries and valve orientations. Pronounced asymmetry in streamwise velocity was present in all cases, while the diseased geometry produced additional asymmetry in radial flows. Quantitative integral metrics demonstrated increased secondary flow strength and recirculation in the rotated orientation for the diseased geometry. CONCLUSIONS The compound effects of geometry and orientation on bioprosthetic valve hemodynamics illustrated in this study could have a crucial impact on long-term valve performance.
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Affiliation(s)
| | | | | | - John K Eaton
- Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Alison L Marsden
- Pediatrics and Bioengineering, Stanford University, Stanford, CA, USA.
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50
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Schmidt S, Flassbeck S, Schmelter S, Schmeyer E, Ladd ME, Schmitter S. The impact of 4D flow displacement artifacts on wall shear stress estimation. Magn Reson Med 2021; 85:3154-3168. [PMID: 33421221 DOI: 10.1002/mrm.28641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the amplitude and spatial distribution of errors in wall shear stress (WSS) values derived from 4D flow measurements caused by displacement artifacts intrinsic to the 4D flow acquisition. METHODS Phase-contrast MRI velocimetry was performed in a model of a stenotic aorta using two different timing schemes, both of which are commonly applied in vivo but differ in their resulting displacement artifacts. Whereas one scheme is optimized to minimize the duration of the encoding gradients (herein called FAST), the other aims to specifically minimize displacement artifacts by synchronizing all three spatial-encoding time points (called ECHO). WSS estimates were calculated and compared to unbiased WSS values obtained by a 5-hour single-point imaging acquisition. In addition, MRI simulations based on computational fluid dynamics data were carried out to investigate the impact of gradient timings corresponding to different spatial resolutions. RESULTS 4D flow displacement artifacts were found to have an impact on the quantified WSS peak values, spatial location, and overall WSS pattern. FAST leads to the underestimation of local WSS values in the phantom arch by up to 90%. Moreover, the corresponding WSS estimates depend on the image orientation. This effect was avoided using ECHO, which, however, results in biased WSS values within the stenosis, yielding an underestimation of peak WSS by up to 17%. Computational fluid dynamics-based simulation results show that the bias in WSS due to displacement artifacts increases with increasing spatial resolution, thus counteracting the resolution benefit for WSS due to reduced partial volume effects and segmentation errors. CONCLUSIONS 4D flow displacement artifacts can significantly impact the WSS estimates and depend on the timing scheme as well as potentially the image orientation. Whereas FAST might allow correct WSS estimation for lower resolutions, ECHO is recommended especially when spatial resolutions of 1 mm and smaller are used. Users need to be aware of this nonnegligible effect, particularly when conducting inter-site studies or studies between vendors. The timing scheme should thus be explicitly mentioned in publications.
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Affiliation(s)
- Simon Schmidt
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Sebastian Flassbeck
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.,Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY, USA
| | - Sonja Schmelter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Ellen Schmeyer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Mark E Ladd
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany.,Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Sebastian Schmitter
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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