Multi-Velocity Encoding 4-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Chronic Aortic Dissection

Sherrah, Andrew G.; Callaghan, Fraser M.; Puranik, Rajesh; Jeremy, Richmond W.; Bannon, Paul G.; Vallely, Michael P.; Grieve, Stuart M.

doi:10.12945/j.aorta.2016.16.046

Cited by 16 publications

(1 citation statement)

References 21 publications

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“…The use of transesophageal ultrasound would additionally need invasive access and is barely applicable for complete assessment of the thoracic aorta. Magnetic resonance imaging offers dynamic quantification of blood volume and velocity during the cardiac cycle in chronic Type B aortic dissection 21 , but might be unreliable in patients with complex flow patterns or hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

High intimal flap mobility assessed by intravascular ultrasound is associated with better short-term results after TEVAR in chronic aortic dissection

Lortz

Παπαθανασίου

Rammos

et al. 2019

Sci Rep

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Thoracic endovascular aortic repair (TEVAR) in chronic aortic dissection remains controversial. We analysed whether a high intimal flap mobility (IFM) of the dissection membrane has an impact on aortic remodelling after TEVAR in chronic Type B aortic dissection. Patients undergoing TEVAR with intravascular ultrasound (IVUS) were analysed and IFM was calculated. High IFM was defined as maximum flap amplitude >3 mm. For determining aortic remodelling, the degree of true lumen (TL) expansion was analysed in the last available follow-up CT. Fifty-two patients (63.6 ± 15.4 years) with a mean follow-up of 26.6 ± 20.7 months were analysed. The mobile flap group (n = 29) showed higher absolute TL expansion at the distal stent-graft (5.9 ± 3.1 vs. 3.3 ± 5.4 mm; p = 0.036) and a higher increase in TL diameter (18 ± 10 vs. 9 ± 15%; p = 0.017) compared to the non-mobile group (n = 23). Basic TEVAR-related outcome characteristics were comparable, but the mobile intimal flap group showed a lower re-intervention rate (3 vs. 8pts.; p = 0.032) in chronic dissections. High IFM in chronic Type B aortic dissection is linked to improved aortic remodelling and is associated with a lower re-intervention rate over time. IVUS assessment of IFM in chronic Type B aortic dissection might be helpful in identifying patients with better remodelling after TEVAR.

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Section: Discussionmentioning

confidence: 99%

High intimal flap mobility assessed by intravascular ultrasound is associated with better short-term results after TEVAR in chronic aortic dissection

Lortz

Παπαθανασίου

Rammos

et al. 2019

Sci Rep

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Computational modeling of the fluid flow and the flexible intimal flap in type B aortic dissection via a monolithic arbitrary Lagrangian/Eulerian fluid‐structure interaction model

Ryzhakov

Soudah

Dialami

2019

Numer Methods Biomed Eng

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In the present work, we perform numerical simulations of the fluid flow in type B aortic dissection (AD), accounting for the flexibility of the intimal flap. The interaction of the flow with the intimal flap is modeled using a monolithic arbitrary Lagrangian/Eulerian fluid‐structure interaction model. The model relies on choosing velocity as the kinematic variable in both domains (fluid and solid) facilitating the coupling. The fluid flow velocity and pressure evolution at different locations is studied and compared against the experimental evidence and the formerly published numerical simulation results. Several tear configurations are analyzed. Details of the fluid flow in the vicinity of the tears are highlighted. Influence of the tear size upon the fluid flow and the flap deformation is discussed.

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Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

Jarvis

Pruijssen

Son

et al. 2019

Magnetic Resonance Imaging

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Background: Systematic evaluation of complex flow in the true lumen and false lumen (TL, FL) is needed to better understand which patients with chronic descending aortic dissection (DAD) are predisposed to complications. Purpose: To develop quantitative hemodynamic maps from 4D flow MRI for evaluating TL and FL flow characteristics. Study Type: Retrospective. Population: In all, 20 DAD patients (age = 60 AE 11 years; 12 male) (six medically managed type B AD [TBAD], 14 repaired type A AD [rTAAD] now with ascending aortic graft [AAo] or elephant trunk [ET1] repair) and 21 age-matched controls (age = 59 AE 10 years; 13 male) were included. Field Strength/Sequence: 1.5T, 3T, 4D flow MRI. Assessment: 4D flow MRI was acquired in all subjects. Data analysis included 3D segmentation of TL and FL and voxelwise calculation of forward flow, reverse flow, flow stasis, and kinetic energy as quantitative hemodynamics maps. Statistical Tests: Analysis of variance (ANOVA) or Kruskal-Wallis tests were performed for comparing subject groups. Correlation and Bland-Altman analysis was performed for the interobserver study. Results: Patients with rTAAD presented with elevated TL reverse flow (AAo repair: P = 0.004, ET1: P = 0.018) and increased TL kinetic energy (AAo repair: P = 0.0002, ET1: P = 0.011) compared to controls. In addition, TL kinetic energy was increased vs. patients with TBAD (AAo repair: P = 0.021, ET1: P = 0.048). rTAAD was associated with higher FL kinetic energy and lower FL stasis compared to patients with TBAD (AAo repair: P = 0.002, ET1: P = 0.024 and AAo repair: P = 0.003, ET1: P = 0.048, respectively). Data Conclusion: Quantitative maps from 4D flow MRI demonstrated global and regional hemodynamic differences between DAD patients and controls. Patients with rTAAD vs. TBAD had significantly altered regional TL and FL hemodynamics. These findings indicate the potential of 4D flow MRI-derived hemodynamic maps to help better evaluate patients with DAD.

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Multi-Velocity Encoding 4-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Chronic Aortic Dissection

Cited by 16 publications

References 21 publications

High intimal flap mobility assessed by intravascular ultrasound is associated with better short-term results after TEVAR in chronic aortic dissection

High intimal flap mobility assessed by intravascular ultrasound is associated with better short-term results after TEVAR in chronic aortic dissection

Computational modeling of the fluid flow and the flexible intimal flap in type B aortic dissection via a monolithic arbitrary Lagrangian/Eulerian fluid‐structure interaction model

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

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