Abnormal Hemodynamics in the Pulmonary Artery Seen on Time-Resolved 3-Dimensional Phase-Contrast Magnetic Resonance Imaging (4D-Flow) in a Young Patient With Idiopathic Pulmonary Arterial Hypertension

Odagiri, Keiichi; Inui, Naoki; Miyakawa, Sachiko; Hakamata, Akio; Wei, Jiazhang; Takehara, Yasuo; Sakahara, Harumi; Sugiyama, Masataka; Alley, Marcus T.; Tran, Quang‐Kim; Watanabe, Hiroshi

doi:10.1253/circj.cj-14-0283

Cited by 14 publications

(7 citation statements)

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“…Furthermore, this method is capable of clearly visualizing blood flow patterns (e.g. vortex formation) and WSS (Odagiri et al 2014 ). Therefore, 4D-flow is a useful method of characterizing blood flow both qualitatively and quantitatively in vivo.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging

et al. 2016

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BackgroundRecently, time-resolved 3D phase contrast magnetic resonance imaging (4D-flow) allows flow dynamics in patients with pulmonary arterial hypertension to be measured. Abnormal flow dynamics, such as vortex blood flow pattern in the pulmonary artery (PA), may reflect progression of pulmonary arterial hypertension (PAH). Some reports suggested that abnormal blood flow parameters including wall shear stress (WSS) could be markers of PAH. However, it was not fully assessed clinical usefulness of these variables. We aimed to assess whether these flow dynamic parameters, such as vortex formation time (VFT) and WSS, were associated with right ventricular (RV) function.ResultsFifteen subjects, nine with PAH and six healthy volunteers, underwent 4D-flow. Differences of Blood flow patterns, blood flow velocities and WSS between PAH patients and healthy volunteers were evaluated. We also assessed the association between VFT, WSS and RV function in PAH patients. Both vortex blood flow patterns and early systolic retrograde flow in the main PA were observed in all patients with PAH. The PA flow velocities and WSS in patients with PAH were lower than those in healthy volunteers, but that blood flow volumes in the MPA, RPA and LPA and SV in the MPA were broadly comparable between the groups. The mean VFT was 35.0 ± 16.6 % of the cardiac cycle. The VFT significantly correlated with RV ejection fraction, RV end systolic volume, and RV end systolic volume index (RVEF = 75.1 + (−85.7)·VFT, p = 0.003, RVESV = 12.4 + 181.8·VFT, p = 0.037 and RVESVI = 10.6 + 114.8·VFT, p = 0.038, respectively) in PAH patients, whereas WSS did not correlate with RV function.ConclusionsWe confirmed that abnormal blood flow dynamics, including the vortex formation and the early onset of retrograde flow, low WSS in the PA were characteristics of PAH. The VFT may be associated with right ventricular dysfunction, whereas WSS was not. Our results suggest that 4D-flow is an effective means of detecting right heart failure as well as diagnosing PAH.Clinical trial registration URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi. Unique identifier: UMIN000011128Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2755-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging

et al. 2016

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“…Wall shear stress is reduced in the proximal pulmonary arteries of PAH patients, and may contribute to pulmonary endothelial cell dysfunction and PAH progression [67]. Wall shear stress can be characterised by four-dimensional flow magnetic resonance with the ability to discriminate PAH patients from normal controls [68–70].…”

Section: Novel Diagnostic Modalitiesmentioning

confidence: 99%

Diagnosis of pulmonary hypertension

et al. 2019

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A revised diagnostic algorithm provides guidelines for the diagnosis of patients with suspected pulmonary hypertension, both prior to and following referral to expert centres, and includes recommendations for expedited referral of high-risk or complicated patients and patients with confounding comorbidities. New recommendations for screening high-risk groups are given, and current diagnostic tools and emerging diagnostic technologies are reviewed.

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“…Alternatively, 4D flow MRI (3D CINE PC-MRI with three-directional velocity encoding) enables post-hoc time-resolved three-dimensional visualization of blood flow and retrospective quantification at any location in a 3D volume [5]. The usefulness of the technique has been increasingly demonstrated for the assessment of blood flow hemodynamics in diverse cardiovascular territories such as the aorta [6], ventricles [7], atria [8], pulmonary arteries [9], intracranial arteries [10], portal [11] and splanchnic arteries [12]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of 4D flow and 2D velocity-encoded phase contrast MRI sequences for the evaluation of aortic hemodynamics

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et al. 2016

Int J Cardiovasc Imaging

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The purpose of this study was to compare aortic flow and velocity quantification using 4D flow MRI and 2D CINE phase-contrast (PC)-MRI with either one-directional (2D-1dir) or three-directional (2D-3dir) velocity encoding. 15 healthy volunteers (51 ± 19 years) underwent MRI including (1) breath-holding 2D-1dir and (2) free breathing 2D-3dir PC-MRI in planes orthogonal to the ascending (AA) and descending (DA) aorta, as well as (3) free breathing 4D flow MRI with full thoracic aorta coverage. Flow quantification included the co-registration of the 2D PC acquisition planes with 4D flow MRI data, AA and DA segmentation, and calculation of AA and DA peak systolic velocity, peak flow and net flow volume for all sequences. Additionally, the 2D-3dir velocity taking into account the through-plane component only was used to obtain results analogous to a free breathing 2D-1dir acquisition. Good agreement was found between 4D flow and 2D-3dir peak velocity (differences = −3 to 6 %), peak flow (−7 %) and net volume (−14 to −9 %). In contrast, breath-holding 2D-1dir measurements exhibited indices significantly lower than free breathing 2D-3dir and 2D-1dir (differences = −35 to −7 %, p < 0.05). Finally, high correlations (r ≥ 0.97) were obtained for indices estimated with or without eddy current correction, with the lowest correlation observed for net volume. 4D flow and 2D-3dir aortic hemodynamic indices were in concordance. However, differences between respiration state and 2D-1dir and 2D-3dir measurements indicate that reference values should be established according to the PC-MRI sequence, especially for the widely used net flow (e.g. stroke volume in the AA).

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Abnormal Hemodynamics in the Pulmonary Artery Seen on Time-Resolved 3-Dimensional Phase-Contrast Magnetic Resonance Imaging (4D-Flow) in a Young Patient With Idiopathic Pulmonary Arterial Hypertension

Cited by 14 publications

References 11 publications

Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging

Non-invasive evaluation of pulmonary arterial blood flow and wall shear stress in pulmonary arterial hypertension with 3D phase contrast magnetic resonance imaging

Diagnosis of pulmonary hypertension

Comparison of 4D flow and 2D velocity-encoded phase contrast MRI sequences for the evaluation of aortic hemodynamics

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