Purpose: To investigate the accuracy of wall shear stress (WSS) estimation using MRI. Specifically, to investigate the impact of different parameters and if MRI WSS estimates are monotonically related to actual WSS. Materials and Methods:The accuracy of WSS estimation using methods based on phase-contrast (PC) MRI velocity mapping, Fourier velocity encoding (FVE) and intravoxel velocity standard deviation mapping were studied using numerical simulations. The influence of spatial resolution, velocity encoding, wall segmentation, and voxel location were investigated over a range of WSS values.Results: WSS estimates were found to be sensitive to parameter settings in general and spatial resolution in particular. All methods underestimated WSS, except for the FVE-based method, which instead was extremely sensitive to voxel position relative to the wall. Methods using PC-based WSS estimation with wall segmentation showed to be accurate for low WSS, but were sensitive to segmentation errors. Conclusion:Even in the absence of noise and for relatively simple velocity profiles, MRI WSS estimates cannot always be assumed to be linearly or even monotonically related to actual WSS. High WSS values cannot be resolved and the estimates depend on parameter setting. Nevertheless, distinguishing areas of low and moderate WSS may be feasible.

95%-CI = 95% confidence interval, COVID-19 = coronavirus disease 2019, FLAIR = fluidattenuated inversion recovery, PCR = polymerase-chain-reaction, rCBF = relative cerebral blood flow, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, SWI = susceptibility-weighted imaging.

Background & Aims The first-line treatment for non-alcoholic fatty liver disease (NAFLD) is weight reduction. Several diets have been proposed, with various effects specifically on liver steatosis. This trial compared the effects of intermittent calorie restriction (the 5:2 diet) and a low-carb high-fat diet (LCHF) on reduction of hepatic steatosis. Methods We conducted an open-label randomised controlled trial that included 74 patients with NAFLD randomised in a 1:1:1 ratio to 12 weeks’ treatment with either a LCHF or 5:2 diet, or general lifestyle advice from a hepatologist (standard of care; SoC). The primary outcome was reduction of hepatic steatosis as measured by magnetic resonance spectroscopy. Secondary outcomes included transient elastography, insulin resistance, blood lipids, and anthropometrics. Results The LCHF and 5:2 diets were both superior to SoC treatment in reducing steatosis (absolute reduction: LCHF: −7.2% [95% CI = −9.3 to −5.1], 5:2: −6.1% [95% CI = −8.1 to −4.2], SoC: −3.6% [95% CI = −5.8 to −1.5]) and body weight (LCHF: −7.3 kg [95% CI = −9.6 to −5.0]; 5:2: −7.4 kg [95% CI = −8.7 to −6.0]; SoC: −2.5 kg [95% CI =−3.5 to −1.5]. There was no difference between 5:2 and LCHF ( p = 0.41 for steatosis and 0.78 for weight). Liver stiffness improved in the 5:2 and SoC but not in the LCHF group. The 5:2 diet was associated with reduced LDL levels and was tolerated to a higher degree than LCHF. Conclusions The LCHF and 5:2 diets were more effective in reducing steatosis and body weight in patients with NAFLD than SoC, suggesting dietary advice can be tailored to meet individual preferences. Lay summary For a person with obesity who suffers from fatty liver, weight loss through diet can be an effective treatment to improve the condition of the liver. Many popular diets that are recommended for weight reduction, such as high-fat diets and diets based on intermittent fasting, have not had their effects on the liver directly evaluated. This study shows that both a low-carb high-fat and the 5:2 diet are effective in treating fatty liver caused by obesity. Clinical Trials Registration This study is registered at Clinicaltrials.gov ( NCT03118310 ).

Time-resolved three-dimensional phase contrast MRI is an important tool for physiological as well as clinical studies of flow in the heart and vessels. The application of the technique is, however, limited by the long scan times required.In the present work, we investigate the feasibility of using spiral readouts to reduce the scan time of 4D flow MRI without sacrificing quality. Three spiral approaches are presented and evaluated in-vivo and in-vitro against a conventional Cartesian acquisition. In-vivo, the performance of each method was assessed in the thoracic aorta in ten volunteers using pathline based analysis and cardiac output analysis. SNR and background phase errors were investigated invitro.Using spiral readouts, the scan times of a 4D flow acquisition of the thoracic aorta could be reduced two to threefold, with no statistically significant difference in pathline validity or cardiac output. The shortened scan time improves the applicability of 4D flow MRI, which may allow the technique to become a part of a clinical workflow for cardiovascular functional imaging.

Phase contrast MRI is a powerful tool for the assessment of blood flow. However, especially in the highly complex and turbulent flow that accompanies many cardiovascular diseases, phase contrast MRI may suffer from artifacts. Simulation of phase contrast MRI of turbulent flow could increase our understanding of phase contrast MRI artifacts in turbulent flows and facilitate the development of phase contrast MRI methods for the assessment of turbulent blood flow. We present a method for the simulation of phase contrast MRI measurements of turbulent flow. The method uses an EulerianLagrangian approach, in which spin particle trajectories are computed from time-resolved large eddy simulations. The Bloch equations are solved for each spin for a frame of reference moving along the spins trajectory. The method was validated by comparison with phase contrast MRI measurements of velocity and intravoxel velocity standard deviation (IVSD) on a flow phantom consisting of a straight rigid pipe with a stenosis. Turbulence related artifacts, such as signal drop and ghosting, could be recognized in the measurements as well as in the simulations. The velocity and the IVSD obtained from the magnitude of the phase contrast MRI simulations agreed well with the measurements. Magn Reson Med 64:1039-1046,

BackgroundFlow volume quantification in the great thoracic vessels is used in the assessment of several cardiovascular diseases. Clinically, it is often based on semi-automatic segmentation of a vessel throughout the cardiac cycle in 2D cine phase-contrast Cardiovascular Magnetic Resonance (CMR) images. Three-dimensional (3D), time-resolved phase-contrast CMR with three-directional velocity encoding (4D flow CMR) permits assessment of net flow volumes and flow patterns retrospectively at any location in a time-resolved 3D volume. However, analysis of these datasets can be demanding. The aim of this study is to develop and evaluate a fully automatic method for segmentation and analysis of 4D flow CMR data of the great thoracic vessels.MethodsThe proposed method utilizes atlas-based segmentation to segment the great thoracic vessels in systole, and registration between different time frames of the cardiac cycle in order to segment these vessels over time. Additionally, net flow volumes are calculated automatically at locations of interest. The method was applied on 4D flow CMR datasets obtained from 11 healthy volunteers and 10 patients with heart failure. Evaluation of the method was performed visually, and by comparison of net flow volumes in the ascending aorta obtained automatically (using the proposed method), and semi-automatically. Further evaluation was done by comparison of net flow volumes obtained automatically at different locations in the aorta, pulmonary artery, and caval veins.ResultsVisual evaluation of the generated segmentations resulted in good outcomes for all the major vessels in all but one dataset. The comparison between automatically and semi-automatically obtained net flow volumes in the ascending aorta resulted in very high correlation (r2=0.926). Moreover, comparison of the net flow volumes obtained automatically in other vessel locations also produced high correlations where expected: pulmonary trunk vs. proximal ascending aorta (r2=0.955), pulmonary trunk vs. pulmonary branches (r2=0.808), and pulmonary trunk vs. caval veins (r2=0.906).ConclusionsThe proposed method allows for automatic analysis of 4D flow CMR data, including vessel segmentation, assessment of flow volumes at locations of interest, and 4D flow visualization. This constitutes an important step towards facilitating the clinical utility of 4D flow CMR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-015-0190-5) contains supplementary material, which is available to authorized users.

Purpose: To develop and evaluate retrospectively gated spiral readout four-dimensional (4D) flow MRI for intracardiac flow analysis. Methods: Retrospectively gated spiral 4D flow MRI was implemented on a 1.5-tesla scanner. The spiral sequence was compared against conventional Cartesian 4D flow (SENSE [sensitivity encoding] 2) in seven healthy volunteers and three patients (only spiral). In addition to comparing flow values, linear regression was used to assess internal consistency of aortic versus pulmonary net volume flows and left ventricular inflow versus outflow using quantitative pathlines analysis. Results: Total scan time with spiral 4D flow was 44% 6 6% of the Cartesian counterpart (13 6 3 vs. 31 6 7 min). Aortic versus pulmonary flow correlated strongly for the spiral sequence (P < 0.05, slope ¼ 1.03, R 2 ¼ 0.88, N ¼ 10), whereas the linear relationship for the Cartesian sequence was not significant (P ¼ 0.06, N ¼ 7). Pathlines analysis indicated good data quality for the spiral (P < 0.05, slope ¼ 1.

Purpose: Evaluate spiral three-dimensional (3D) phase contrast MRI for the assessment of turbulence and velocity in stenotic flow. Methods: A-stack-of-spirals 3D phase contrast MRI sequence was evaluated in vitro against a conventional Cartesian sequence. Measurements were made in a flow phantom with a 75% stenosis. Both spiral and Cartesian imaging were performed using different scan orientations and flow rates. Volume flow rate, maximum velocity and turbulent kinetic energy (TKE) were computed for both methods. Moreover, the estimated TKE was compared with computational fluid dynamics (CFD) data. Results: There was good agreement between the turbulent kinetic energy from the spiral, Cartesian and CFD data. Flow rate and maximum velocity from the spiral data agreed well with Cartesian data. As expected, the short echo time of the spiral sequence resulted in less prominent displacement artifacts compared with the Cartesian sequence. However, both spiral and Cartesian flow rate estimates were sensitive to displacement when the flow was oblique to the encoding directions. Conclusion: Spiral 3D phase contrast MRI appears favorable for the assessment of stenotic flow. The spiral sequence was more than three times faster and less sensitive to displacement artifacts when compared with a conventional Cartesian sequence. Magn Reson Med 75:1249-1255, 2016. V C 2015 Wiley Periodicals, Inc.