Evaluating a Phase‐Specific Approach to Aortic Flow: A <scp>4D</scp> Flow <scp>MRI</scp> Study

Ramaekers, Mitch J F G; Westenberg, Jos J.M.; Venner, Monica; Juffermans, Joe F; Assen, H.C. van; Kiefte, B.J.C. Te; Adriaans, Bouke P.; Lamb, Hildo J.; Wildberger, Joachim E.; Schalla, Simon

doi:10.1002/jmri.28852

Cited by 3 publications

(1 citation statement)

References 27 publications

(70 reference statements)

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“…These sources of variable and erroneous segmentation could most likely be decreased in future studies by the implementation of an automated segmentation method. For example, adaptation of existing software to 3D cine bSSFP, [35][36][37] an atlas-based strategy, 38 or a deep-learning strategy using a convolutional neural network [39][40][41] could be used.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of 3D thoracic aortic displacement from 3D cine balanced SSFP at 3 T without contrast enhancement

Merton,

Bosshardt,

Strijkers

et al. 2023

Magnetic Resonance in Med

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PurposeAortic motion has direct impact on the mechanical stresses acting on the aorta. In aortic disease, increased stiffness of the aorta may lead to decreased aortic motion over time, which could be a predictor for aortic dissection or rupture. This study investigates the reproducibility of obtaining 3D displacement and diameter maps quantified using accelerated 3D cine MRI at 3 T.MethodsA noncontrast‐enhanced, free‐breathing 3D cine sequence based on balanced SSFP and pseudo‐spiral undersampling with high spatial isotropic resolution was developed (spatial/temporal resolution [1.6 mm]3/67 ms). The thoracic aorta of 14 healthy volunteers was prospectively scanned three times at 3 T: twice on the same day and a third time 2 weeks later. Aortic displacement was calculated using iterative closest point nonrigid registration of manual segmentations of the 3D aorta at end‐systole and mid‐diastole. Interexamination and interobserver regional analysis of mean displacement for five regions of interest was performed using Bland–Altman analysis. Additionally, a complementary voxel‐by‐voxel analysis was done, allowing a more local inspection of the method.ResultsNo significant differences were found in mean and maximum displacement for any of the regions of interest for the interexamination and interobserver analysis. The maximum displacement measured in the lower half of the ascending aorta was 11.0 ± 3.4 mm (range: 3.0–17.5 mm) for the first scan. The smallest detectable change in mean displacement in the lower half of the ascending aorta was 3 mm.ConclusionDetailed 3D cine balanced SSFP at 3 T allows for reproducible quantification of systolic–diastolic mean aortic displacement within acceptable limits.

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Section: Discussionmentioning

confidence: 99%

Reproducibility of 3D thoracic aortic displacement from 3D cine balanced SSFP at 3 T without contrast enhancement

Merton,

Bosshardt,

Strijkers

et al. 2023

Magnetic Resonance in Med

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Editorial for “Evaluating a Phase‐Specific Approach to Aortic Flow: A 4D Flow MRI Study”

Cebull

Oshinski

2023

Magnetic Resonance Imaging

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F our dimensional flow magnetic resonance imaging (4D flow MRI) has been used to measure in vivo blood flow from small, cerebral vessels to the aorta. It can capture the complex flow patterns of the aorta in three dimensions throughout the cardiac cycle. This ability enables in depth characterization of blood flow in various aortopathies. 1 Because it is an emerging technique with limited clinical implementation, studies to find the best post-processing and analysis techniques are ongoing. 2 The vessel wall of the aorta can deform more than 7% during the cardiac cycle in addition to undergoing translation from heart motion and surrounding structures. 3,4 The aortic wall boundary is typically determined from a maximum intensity projection or at peak systole of the magnitude MR image, 5 while others have registered computed tomography data with the 4D flow datasets. 6 However, accounting for aortic motion in the segmentation of 4D flow data may improve the accuracy of flow-derived metrics, particularly metrics directly relating to the aortic wall such as wall shear stress (WSS) and oscillatory shear index (OSI). 7 In this study, the authors seek to evaluate how phasespecific segmentation of the aorta affects flow characterization from 4D flow MRI. 8 4D flow MRI was acquired for 40 nondisease subjects and 10 subjects with dilated aortas. Segmentations of the magnitude image were performed at seven time points during the systolic phase of the cardiac cycle in the aortic root and the ascending aorta, while the remainder of the aorta was segmented at peak systole. They evaluated various flow metrics in both multi-phase and single-phase models which included velocity, vorticity, helicity, kinetic energy, and viscous energy loss. They found that time-averaged values were comparable between the two segmentation methods, but flow metrics at peak systole varied between multi-and single-phase approaches. In addition, they compared time-averaged flow parameters to peak values and found a correlation between the two, suggesting that measuring peak values may be sufficient for 4D flow MRI analysis. This finding could be important for reducing analysis time but should not replace time-averaged or diastolic flow analysis in diseases where diastolic flow differences may be significant such as false lumen flow in aortic dissections.

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Four-dimensional flow magnetic resonance imaging for noninvasive diagnosis of clinically significant portal hypertension and high-risk gastroesophageal varices in patients with cirrhosis

Ji,

Xiang,

Dong

et al. 2024

EngMedicine

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Evaluating a Phase‐Specific Approach to Aortic Flow: A 4D Flow MRI Study

Cited by 3 publications

References 27 publications

Reproducibility of 3D thoracic aortic displacement from 3D cine balanced SSFP at 3 T without contrast enhancement

Reproducibility of 3D thoracic aortic displacement from 3D cine balanced SSFP at 3 T without contrast enhancement

Editorial for “Evaluating a Phase‐Specific Approach to Aortic Flow: A 4D Flow MRI Study”

Four-dimensional flow magnetic resonance imaging for noninvasive diagnosis of clinically significant portal hypertension and high-risk gastroesophageal varices in patients with cirrhosis

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