Flow Assessment Through Four Heart Valves Simultaneously Using 3-Dimensional 3-Directional Velocity-Encoded Magnetic Resonance Imaging With Retrospective Valve Tracking in Healthy Volunteers and Patients With Valvular Regurgitation

Roes, Stijntje D.; Hammer, Sebastiaan; Geest, Rob J. van der; Marsan, Nina Ajmone; Bax, Jeroen J.; Lamb, Hildo J.; Reiber, Johan H. C.; Roos, Albert de; Westenberg, Jos J.M.

doi:10.1097/rli.0b013e3181ae99b5

Cited by 125 publications

(143 citation statements)

References 30 publications

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“…In a small population of patients with congenital heart disease, we showed that these rendering methods for 4D phasecontrast data showed sensitivity comparable to that of echocardiography. Once identified, the same 4D phase-contrast data can be used to quantify the severity of insufficiency at each valve (9)(10)(11). Extracardiac shunts were also readily delineated with the 4D phase-contrast sequence; however, the number of pulmonary venous return (Fig 3).…”

Section: Cardiac Imaging: Valvular Insufficiency and Shunts Hsiao Et Almentioning

confidence: 99%

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Evaluation of Valvular Insufficiency and Shunts with Parallel-imaging Compressed-sensing 4D Phase-contrast MR Imaging with Stereoscopic 3D Velocity-fusion Volume-rendered Visualization

Hsiao¹,

Lustig²,

Alley³

et al. 2012

Radiology

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Purpose:To assess the potential of compressed-sensing parallel-imaging four-dimensional (4D) phase-contrast magnetic resonance (MR) imaging and specialized imaging software in the evaluation of valvular insufficiency and intracardiac shunts in patients with congenital heart disease. Materials andMethods:Institutional review board approval was obtained for this HIPAAcompliant study. Thirty-four consecutive retrospectively identified patients in whom a compressed-sensing parallel-imaging 4D phase-contrast sequence was performed as part of routine clinical cardiac MR imaging between March 2010 and August 2011 and who had undergone echocardiography were included. Multiplanar, volume-rendered, and stereoscopic three-dimensional velocityfusion visualization algorithms were developed and implemented in Java and OpenGL. Two radiologists independently reviewed 4D phase-contrast studies for each of 34 patients (mean age, 6 years; age range, 10 months to 21 years) and tabulated visible shunts and valvular regurgitation. These results were compared with color Doppler echocardiographic and cardiac MR imaging reports, which were generated without 4D phase-contrast visualization. Cohen k statistics were computed to assess interobserver agreement and agreement with echocardiographic results. Results:The 4D phase-contrast acquisitions were performed, on average, in less than 10 minutes. Among 123 valves seen in 34 4D phasecontrast studies, 29 regurgitant valves were identified, with good agreement between observers (k = 0.85). There was also good agreement with the presence of at least mild regurgitation at echocardiography (observer 1, k = 0.76; observer 2, k = 0.77) with high sensitivity (observer 1, 75%; observer 2, 82%) and specificity (observer 1, 97%; observer 2, 95%) relative to the reference standard. Eight intracardiac shunts were identified, four of which were not visible with conventional cardiac MR imaging but were detected with echocardiography. No intracardiac shunts were found with echocardiography alone. Conclusion:With velocity-fusion visualization, the compressed-sensing parallel-imaging 4D phase-contrast sequence can augment conventional cardiac MR imaging by improving sensitivity for and depiction of hemodynamically significant shunts and valvular regurgitation.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Section: Cardiac Imaging: Valvular Insufficiency and Shunts Hsiao Et Almentioning

confidence: 99%

“…Contrast material-enhanced MR angiograpy was performed with an inhouse three-dimensional spoiled gradient-echo sequence that enabled both parallel-imaging and compressed-sensing reconstruction. By excluding the MR imaging (9), and that in certain circumstances, its precision may exceed that of 2D phase-contrast MR imaging (10,11).…”

Section: Advances In Knowledgementioning

confidence: 99%

Evaluation of Valvular Insufficiency and Shunts with Parallel-imaging Compressed-sensing 4D Phase-contrast MR Imaging with Stereoscopic 3D Velocity-fusion Volume-rendered Visualization

Hsiao¹,

Lustig²,

Alley³

et al. 2012

Radiology

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“…Among a cohort of 64 patients with functional (35). These data build upon earlier pilot studies supporting use of 4D flow for MR assessment (36,37). Challenges of 4D flow application in current clinical practice include prolonged acquisition times (typically 5-10 minutes) as well as requisite pre-determination of peak sample velocities (for which inaccuracies can produce aliasing and limit data utility) (31).…”

Section: Quantification Of Mrmentioning

confidence: 99%

Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

et al. 2017

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Mitral regurgitation (MR) is a common cause of morbidity worldwide and an accepted indication for interventional therapies which aim to reduce or resolve adverse clinical outcomes associated with MR.Cardiac magnetic resonance (CMR) provides highly accurate means of assessing MR, including a variety of approaches that can measure MR based on quantitative flow. Additionally, CMR is widely accepted as a reference standard for cardiac chamber quantification, enabling reliable detection of subtle changes in cardiac chamber size and function so as to guide decision-making regarding timing of mitral valve directed therapies. Beyond geometric imaging, CMR enables tissue characterization of ischemia and infarction in the left ventricular (LV) myocardium as well as within the mitral valve apparatus, thus enabling identification of structural substrates for MR. This review provides an overview of established and emerging CMR approaches to measure valvular regurgitation, including relative utility of different approaches for patients with primary or secondary MR. Clinical outcomes studies are discussed with focus on data demonstrating advantages of CMR for guiding diagnosis, risk stratification, and management of patients with known or suspected MR. Comparative data is reviewed with focus on diagnostic performance of CMR in comparison to conventional assessment via echocardiography (echo). Emerging literature is reviewed concerning potential new approaches that utilize CMR tissue characterization to guide clinical decision-making in order to improve therapeutic outcomes and clinical prognosis for patients with MR. J Thorac Dis 2017;9(Suppl 4):S246-S256 jtd.amegroups.com pre-operative morbidity and decreases procedural efficacy (9,10), possibly due to impact of LV or left atrial (LA) dilation on mitral apparatus geometry or wall stress (11-13). Accordingly, consensus guidelines recommend surgery for patients with severe primary MR if symptoms are present or, in the case of asymptomatic individuals, if LV dysfunction (ejection fraction <60%) or chamber dilation (end-systolic diameter ≥40 mm) is present (14). Echocardiography (echo) is widely used to guide decision-making concerning timing of interventional therapies for MR (14). However, echo can be suboptimal for this purpose, as image quality can vary (15), chamber quantification is typically predicated on 2-dimensional (2D) geometric assumptions [rather than 3-dimensional (3D) imaging] (16), and MR quantification can be challenging in the context of regurgitant jet eccentricity (17). These limitations may explain recent data suggesting lack of correlation between pre-operative echo-quantified MR severity and LV reverse remodeling after mitral valve surgery (18). Knowledge gaps regarding predictors of procedural success limit the ability to optimize decision-making for patients with MR.Cardiac magnetic resonance (CMR) can assess MR as well as its predisposing risk factors. A variety of CMR pulse sequences can be used for MR assessment ( Table 1). Phase velocity en...

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“…When accurate volume flow assessment is the predominant aim, direct integration of the velocities in a 2D slice, through the 3D data is preferred(19). If retrospective valve tracking is used in this approach, volume flow can even be obtained through all four heart valves simultaneously (31,32).…”

Section: Flow Visualization and Quantification Techniquesmentioning

confidence: 99%

Flow Imaging: Cardiac Applications of 3D Cine Phase-Contrast MRI

Ebbers

2011

Curr Cardiovasc Imaging Rep

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Global and regional blood flow dynamics are of pivotal importance to cardiac function. Fluid mechanical forces can affect hemolysis and platelet aggregation, as well as myocardial remodeling. In recent years, assessment of blood flow patterns based on time-resolved, three-dimensional, three-directional phasecontrast magnetic resonance imaging (3D cine PC MRI)(1) has become possible and rapidly gained popularity. Initially, this technique was mainly known for its intuitive and appealing visualizations of the cardiovascular blood flow. Most recently, the technique has begun to go beyond compelling images towards comprehensive and quantitative assessment of blood flow. In this article, cardiac applications of 3D cine PC MRI data are discussed, starting with a review of the acquisition and analysis techniques, and including descriptions of promising applications of cardiac 3D cine PC MRI for the clinical evaluation of myocardial, valvular and vascular disorders.3

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Flow Assessment Through Four Heart Valves Simultaneously Using 3-Dimensional 3-Directional Velocity-Encoded Magnetic Resonance Imaging With Retrospective Valve Tracking in Healthy Volunteers and Patients With Valvular Regurgitation

Abstract: Flow assessment using 3D 3-directional VE MR with retrospective valve-tracking during off-line analysis enables accurate quantification of net flow volumes through 4 heart valves within a single acquisition in healthy volunteers and in patients with valvular regurgitation.

Cited by 125 publications

References 30 publications

Evaluation of Valvular Insufficiency and Shunts with Parallel-imaging Compressed-sensing 4D Phase-contrast MR Imaging with Stereoscopic 3D Velocity-fusion Volume-rendered Visualization

Evaluation of Valvular Insufficiency and Shunts with Parallel-imaging Compressed-sensing 4D Phase-contrast MR Imaging with Stereoscopic 3D Velocity-fusion Volume-rendered Visualization

Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

Flow Imaging: Cardiac Applications of 3D Cine Phase-Contrast MRI

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