4D flow MRI hemodynamic biomarkers for cerebrovascular diseases

Abstract

Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time‐resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health. The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain‐wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow‐up of interventions aiming to restore a normal cerebral circulation. Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest.

5‐Year Associations among Cerebral Arterial Pulsatility, Perivascular Space Dilation, and White Matter Lesions

“…Hence, previous studies have not examined the possibility that PVS and WML progression could co‐occur with, or precede, increases in cerebral arterial pulsatility. The technique 4D flow MRI offers time‐resolved 3D velocity encoding and angiographic imaging of the whole brain in a single scan 11, 12 . Semi‐automatic post‐processing methods using centerline processing schemes 13, 14 have made 4D flow feasible for investigating arterial stiffness and pulsatility in major 15, 16 as well as small cerebral arteries 17, 18 .…”

“…The technique 4D flow MRI offers time‐resolved 3D velocity encoding and angiographic imaging of the whole brain in a single scan. 11 , 12 Semi‐automatic post‐processing methods using centerline processing schemes 13 , 14 have made 4D flow feasible for investigating arterial stiffness and pulsatility in major 15 , 16 as well as small cerebral arteries. 17 , 18 By using such post‐processing, age‐sensitive metrics of pulsatility can be obtained simultaneously over the cerebral vasculature.…”

Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review

“…In addition, there is increased interest in characterizing velocity using 4D Flow MRI. This is an advanced phase-contrast MRI technique which allows non-invasive quantifications of blood flow to characterize the hemodynamic impact of intracranial atherosclerosis and identify hemodynamic biomarkers ( 96 ) ( Figure 9 ). While studies to date share limitations including long scan duration, low spatial/temporal resolutions and associated tradeoffs ( 97 ), this is a promising emerging technique.…”

Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: a narrative review

“…Alongside clinical presentation and laboratory tests, neuroimaging techniques have become prevailing tools in differential diagnosis of CVDs. Magnetic resonance imaging (MRI), originally named nuclear magnetic resonance, excels other neuroimaging techniques by its features of non-invasive, diverse models/sequences and high spatiotemporal resolution and thus, becomes a powerful tool in differential diagnosis of a variety of CVDs (2,4). Previously, many excellent reviews of neuroimaging have been published.…”