4D flow imaging of the thoracic aorta: is there an added clinical value?

Catapano, Federica; Pambianchi, Giacomo; Cundari, Giulia; Rebelo, Joana; Cilia, Francesco; Carbone, Iacopo; Catalano, Carlo; Francone, Marco; Galea, Nicola

doi:10.21037/cdt-20-452

Cited by 21 publications

(8 citation statements)

References 115 publications

(163 reference statements)

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“…On the other hand, Patients 2 and 4 exhibited non-zero TL RFIs and had the CA and left renal artery perfused by the FL. These findings support the previously postulated hypothesis that reversed flow may be related to distal reentry pathways into the FL with higher pressure, causing disturbances of blood stream and retrograde flow in the TL (Catapano et al, 2020). This correlation is further backed up by the overall higher RFI in the TL than in the FL of Patient 2 (Figure 5).…”

Section: Discussionsupporting

confidence: 90%

Qualitative and Quantitative Assessments of Blood Flow on Tears in Type B Aortic Dissection With Different Morphologies

Saitta

Guo

Pirola

et al. 2021

Front. Bioeng. Biotechnol.

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Objective: The interactions between aortic morphology and hemodynamics play a key role in determining type B aortic dissection (TBAD) progression and remodeling. The study aimed to provide qualitative and quantitative hemodynamic assessment in four different TBAD morphologies based on 4D flow MRI analysis.Materials and Methods: Four patients with different TBAD morphologies underwent CT and 4D flow MRI scans. Qualitative blood flow evaluation was performed by visualizing velocity streamlines and flow directionality near the tears. Quantitative analysis included flow rate, velocity and reverse flow index (RFI) measurements. Statistical analysis was performed to evaluate hemodynamic differences between the true lumen (TL) and false lumen (FL) of patients.Results: Qualitative analysis revealed blood flow splitting near the primary entry tears (PETs), often causing the formation of vortices in the FL. All patients exhibited clear hemodynamic differences between TL and FL, with the TL generally showing higher velocities and flow rates, and lower RFIs. Average velocity magnitude measurements were significantly different for Patient 1 (t = 5.61, p = 0.001), Patient 2 (t = 3.09, p = 0.02) and Patient 4 (t = 2.81, p = 0.03). At follow-up, Patient three suffered from left renal ischemia because of FL collapse. This patient presented a complex morphology with two FLs and marked flow differences between TL and FLs. In Patient 4, left renal artery malperfusion was observed at the 32-months follow-up, due to FL thrombosis growing after PET repair.Conclusion: The study demonstrates the clinical feasibility of using 4D flow MRI in the context of TBAD. Detailed patient-specific hemodynamics assessment before treatment may provide useful insights to better understand this pathology in the future.

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Section: Discussionsupporting

confidence: 90%

Qualitative and Quantitative Assessments of Blood Flow on Tears in Type B Aortic Dissection With Different Morphologies

Saitta

Guo

Pirola

et al. 2021

Front. Bioeng. Biotechnol.

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“…These studies demonstrated that the wall shear stress and the oscillatory shear index were higher in the curved proximal descending aorta compared with the mid-descending thoracic aorta, as well as more frequent non-physiological vortex flow could be observed. [21][22][23] In our results, group A tended to have more intimal tear of visceral arteries, more false lumen branch arteries perfused, and larger false lumen volume. Hence, we hypothesized that the shorter the PIT-LSA distance, the more susceptible the dissection progression is to complicated hemodynamics, in turn causing more complex morphological change.…”

Section: Discussionsupporting

confidence: 52%

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

Rong

et al. 2021

J Endovasc Ther

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Purpose: The purpose of this study was to evaluate the association between the distance from the primary intimal tear (PIT) to the left subclavian artery (LSA) (PIT–LSA distance) and the risk of aortic enlargement after thoracic endovascular aortic repair (TEVAR). Methods: This is a retrospective cohort study. A total of 228 patients were reviewed from the database of the Registry Of type B aortic dissection with the Utility of STent graft (ROBUST) study performed from January 1, 2011, to December 31, 2016. Of them, 196 patients were eligible for analysis. The PIT–LSA distance was defined as the length from the distal edge of the LSA orifice to the proximal edge of the PIT along the centerline of the true lumen. According to the border between zone 3 and zone 4 of the Ishimaru classification, patients were divided into group A (n = 117, PIT–LSA distance ≤ 2 cm) and group B (n = 79, PIT–LSA distance > 2 cm). Thoracic aortic enlargement (TAE) was defined as a thoracic aortic volume increase of ≥20%. Multivariate Cox regression was used to estimate the association between the PIT–LSA distance and risk of TAE after TEVAR. Results: The mean age was 52.3 ± 11.6 years, and 88.8% of patients were male. There were no significant differences between groups in demographic and baseline characteristics. The PIT–LSA distance was 1.1 cm (range, −1.6 to 2.0 cm) in group A, and 2.9 cm (range, 2.1–12.6 cm) in group B. TAE occurred in 27 patients in group A, and 6 in group B. The mean follow-up was 12.4 months (range, 0.10–83.1 months) in group A, and 12.63 months (range, 0.10–82.77 months) in group B. The cumulative 12- and 24-month rates of freedom from TAE were 79.0% and 71.3% in group A, versus 92.5% and 92.5% in group B, respectively. Multivariate Cox regression analysis revealed that the PIT–LSA distance was an independent predictor of TAE after TEVAR (adjusted hazard ratio, 0.66; 95% confidence interval, 0.48–0.90; p = 0.009). Conclusion: Patients with a more proximal PIT location have a higher incidence of thoracic aortic enlargement after TEVAR. The location of the PIT in relation to the LSA can be used to identify patients who need closed surveillance after TEVAR or early preemptive intervention.

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“…Because dissection and rupture are commonly associated with hypertension, there is a developing interest in the role of hemodynamics in the pathophysiology of aortic disease. Four-dimensional flow magnetic resonance imaging (4D flow MRI) is an emerging noninvasive imaging modality that provides comprehensive insight into aortic hemodynamics 11–13 . The technique facilitates acquisition of time-resolved 3-dimensional (3D) 3-directionally encoded velocity data and allows for visualization and quantification of flow patterns and flow-derived hemodynamic markers 14 .…”

mentioning

confidence: 99%

Characterization of Ascending Aortic Flow in Patients With Degenerative Aneurysms

et al. 2021

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Objectives: Degenerative thoracic aortic aneurysm (TAA) patients are known to be at risk of life-threatening acute aortic events. Guidelines recommend preemptive surgery at diameters of greater than 55 mm, although many patients with small aneurysms show only mild growth rates and more than half of complications occur in aneurysms below this threshold. Thus, assessment of hemodynamics using 4-dimensional flow magnetic resonance has been of interest to obtain more insights in aneurysm development. Nonetheless, the role of aberrant flow patterns in TAA patients is not yet fully understood. Materials and Methods: A total of 25 TAA patients and 22 controls underwent time-resolved 3-dimensional phase contrast magnetic resonance imaging with 3-directional velocity encoding (ie, 4-dimensional flow magnetic resonance imaging). Hemodynamic parameters such as vorticity, helicity, and wall shear stress (WSS) were calculated from velocity data in 3 anatomical segments of the ascending aorta (root, proximal, and distal). Regional WSS distribution was assessed for the full cardiac cycle. Results: Flow vorticity and helicity were significantly lower for TAA patients in all segments. The proximal ascending aorta showed a significant increase in peak WSS in the outer curvature in TAA patients, whereas WSS values at the inner curvature were significantly lower as compared with controls. Furthermore, positive WSS gradients from sinotubular junction to midascending aorta were most prominent in the outer curvature, whereas from midascending aorta to brachiocephalic trunk, the outer curvature showed negative WSS gradients in the TAA group. Controls solely showed a positive gradient at the inner curvature for both segments. Conclusions: Degenerative TAA patients show a decrease in flow vorticity and helicity, which is likely to cause perturbations in physiological flow patterns.The subsequent differing distribution of WSS might be a contributor to vessel wall remodeling and aneurysm formation.

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4D flow imaging of the thoracic aorta: is there an added clinical value?

Cited by 21 publications

References 115 publications

Qualitative and Quantitative Assessments of Blood Flow on Tears in Type B Aortic Dissection With Different Morphologies

Qualitative and Quantitative Assessments of Blood Flow on Tears in Type B Aortic Dissection With Different Morphologies

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study

Characterization of Ascending Aortic Flow in Patients With Degenerative Aneurysms

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