Cardiovascular Magnetic Resonance Imaging of Atrial Fibrillation: An Advanced Hemodynamic Perspective

Ghuman, Mankarman; Kim, Han-Suk; Sheitt, Hana; García, Julio

doi:10.5772/intechopen.105498

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“…Cross-sectional transesophageal echocardiography studies have indicated the association of flow velocity in the left atrium (LA) and left atrial appendage (LAA) with thromboembolic risk in patients with AF ( 7 , 8 ). Furthermore, phase-contrast cardiovascular magnetic resonance (CMR) with flow-encoding in all three spatial directions (4D-flow) provides 3D blood velocity information in 3D volume throughout the cardiac cycle ( 9 – 11 ). With its power of visualization and quantification, this technique opened new horizons in understanding cardiovascular flow and has been used to assess flow patterns and parameters, including velocity, stasis, and vorticity in LA and LAA in patients with AF ( 12 – 22 ).…”

Section: Introductionmentioning

confidence: 99%

Left atrium 4D-flow segmentation with high-resolution contrast-enhanced magnetic resonance angiography

Kim,

Wilton,

Garcia

2023

Front. Cardiovasc. Med.

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BackgroundAtrial fibrillation (AF) leads to intracardiac thrombus and an associated risk of stroke. Phase-contrast cardiovascular magnetic resonance (CMR) with flow-encoding in all three spatial directions (4D-flow) provides a time-resolved 3D volume image with 3D blood velocity, which brings individual hemodynamic information affecting thrombus formation. As the resolution and contrast of 4D-flow are limited, we proposed a semi-automated 4D-flow segmentation method for the left atrium (LA) using a standard-of-care contrast-enhanced magnetic resonance angiography (CE-MRA) and registration technique.MethodsLA of 54 patients with AF were segmented from 4D-flow taken in sinus rhythm using two segmentation methods. (1) Phase-contrast magnetic resonance angiography (PC-MRA) was calculated from 4D-flow, and LA was segmented slice-by-slice manually. (2) LA and other structures were segmented from CE-MRA and transformed into 4D-flow coordinates by registration with the mutual information method. Overlap of volume was tested by the Dice similarity coefficient (DSC) and the average symmetric surface distance (ASSD). Mean velocity and stasis were calculated to compare the functional property of LA from two segmentation methods.ResultsLA volumes from segmentation on CE-MRA were strongly correlated with PC-MRA volume, although mean CE-MRA volumes were about 10% larger. The proposed registration scheme resulted in visually successful registration in 76% of cases after two rounds of registration. The mean of DSC of the registered cases was 0.770 ± 0.045, and the mean of ASSD was 2.704 mm ± 0.668 mm. Mean velocity had no significant difference between the two segmentation methods, and mean stasis had a 3.3% difference.ConclusionThe proposed CE-MRA segmentation and registration method can generate segmentation for 4D-flow images. This method will facilitate 4D-flow analysis for AF patients by making segmentation easier and overcoming the limit of resolution.

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