Dataset Information

Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time.

ABSTRACT:

Background

Cardiovascular magnetic resonance (CMR) can potentially quantify aortic valve area (AVA) in aortic stenosis (AS) using a single-slice phase contrast (PC) acquisition at valve level: AVA = aortic flow/aortic velocity-time integral (VTI). However, CMR has been shown to underestimate aortic flow in turbulent high velocity jets, due to intra-voxel dephasing. This study investigated the effect of decreasing intra-voxel dephasing by reducing the echo time (TE) on AVA estimates in patients with AS.

Method

15 patients with moderate or severe AS, were studied with three different TEs (2.8 ms/2.0 ms/1.5 ms), in the main pulmonary artery (MPA), left ventricular outflow tract (LVOT) and 0 cm/1 cm/2.5 cm above the aortic valve (AoV). PC estimates of stroke volume (SV) were compared with CMR left ventricular SV measurements and PC peak velocity, VTI and AVA were compared with Doppler echocardiography. CMR estimates of AVA obtained by direct planimetry from cine acquisitions were also compared with the echoAVA.

Results

With a TE of 2.8 ms, the mean PC SV was similar to the ventricular SV at the MPA, LVOT and AoV0 cm (by Bland-Altman analysis bias +/- 1.96 SD, 1.3 +/- 20.2 mL/-6.8 +/- 21.9 mL/6.5 +/- 50.7 mL respectively), but was significantly lower at AoV1 and AoV2.5 (-29.3 +/- 31.2 mL/-21.1 +/- 35.7 mL). PC peak velocity and VTI underestimated Doppler echo estimates by approximately 10% with only moderate agreement. Shortening the TE from 2.8 to 1.5 msec improved the agreement between ventricular SV and PC SV at AoV0 cm (6.5 +/- 50.7 mL vs 1.5 +/- 37.9 mL respectively) but did not satisfactorily improve the PC SV estimate at AoV1 cm and AoV2.5 cm. Agreement of CMR AVA with echoAVA was improved at TE 1.5 ms (0.00 +/- 0.39 cm2) versus TE 2.8 (0.11 +/- 0.81 cm2). The CMR method which agreed best with echoAVA was direct planimetry (-0.03 cm2 +/- 0.24 cm2).

Conclusion

Agreement of CMR AVA at the aortic valve level with echo AVA improves with a reduced TE of 1.5 ms. However, flow measurements in the aorta (AoV 1 and 2.5) are underestimated and 95% limits of agreement remain large. Further improvements or novel, more robust techniques are needed in the CMR PC technique in the assessment of AS severity in patients with moderate to severe aortic stenosis.

SUBMITTER: O'Brien KR

PROVIDER: S-EPMC2785795 | biostudies-literature | 2009 Nov

REPOSITORIES: biostudies-literature

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Publications

Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time.

O'Brien Kieran R KR Gabriel Ruvin S RS Greiser Andreas A Cowan Brett R BR Young Alistair A AA Kerr Andrew J AJ

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 20091119

<h4>Background</h4>Cardiovascular magnetic resonance (CMR) can potentially quantify aortic valve area (AVA) in aortic stenosis (AS) using a single-slice phase contrast (PC) acquisition at valve level: AVA = aortic flow/aortic velocity-time integral (VTI). However, CMR has been shown to underestimate aortic flow in turbulent high velocity jets, due to intra-voxel dephasing. This study investigated the effect of decreasing intra-voxel dephasing by reducing the echo time (TE) on AVA estimates in pa ...[more]

PMID: 19925667

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Project description:BackgroundTransthoracic echocardiography (TTE) is the diagnostic routine standard for assessing aortic stenosis (AS). However, its inaccuracies in determining stroke volume (SV) and aortic valve area (AVA) call for a more precise and dependable method. Phase-contrast cardiovascular magnetic resonance imaging (PC-CMR) is a promising tool to push these boundaries. Thus, the aim of this study was to validate a novel approach based on PC-CMR against the gold-standard of invasive determination of AVA in AS compared to TTE.MethodsA total of 50 patients with moderate or severe AS underwent TTE, cardiac catheterization and CMR. AVA via PC-CMR was determined by plotting momentary flow across the valve against flow-velocity. SV by CMR was measured directly via PC-CMR and volumetrically using cine-images. Invasive SV and AVA were determined via Fick-principle and Gorlin-formula, respectively. TTE yielded SV and AVA using continuity equation. Gradients were calculated via the modified Bernoulli-equation.ResultsSV by PC-CMR (85 ± 31 ml) correlated strongly (r: 0.73, p < 0.001) with cine-CMR (85 ± 19 ml) without significant bias (lower and upper limits of agreement (LLoA and ULoA): - 41 ml and 44 ml, p = 0.83). In PC-CMR, mean pressure gradient correlated significantly with invasive determination (r: 0.36, p = 0.011). Mean AVA, as determined by PC-CMR during systole (0.78 ± 0.25 cm2), correlated moderately (r: 0.54, p < 0.001) with invasive AVA (0.70 ± 0.23 cm2), resulting in a small bias of 0.08 cm2 (LLoA and ULoA: - 0.36 cm2 and 0.55 cm2, p = 0.017). Inter-methodically, AVA by TTE (0.81 ± 0.23 cm2) compared to invasive determination showed similar correlations (r: 0.58, p < 0.001 with a bias of 0.11 cm2, LLoA and ULoA: - 0.30 and 0.52, p < 0.001) to PC-CMR. Intra- and interobserver reproducibility were excellent for AVA (intraclass-correlation-coefficients of 0.939 and 0.827, respectively).ConclusionsOur novel approach using continuous determination of flow-volumes and velocities with PC-CMR enables simple AVA measurement with no bias to invasive assessment. This approach highlights non-invasive AS grading through CMR, especially when TTE findings are inconclusive.

Project description:ObjectivesBicuspid aortic valve patients can develop thoracic aortic aneurysms and therefore require serial imaging to monitor aortic growth. This study investigates the reliability of contrast-enhanced magnetic resonance angiography (CEMRA) volumetry compared with 2-dimensional diameter measurements to identify thoracic aortic aneurysm growth.Materials and methodsA retrospective, institutional review board-approved, and Health Insurance Portability and Accountability Act-compliant study was conducted on 20 bicuspid aortic valve patients (45 ± 8.9 years, 20% women) who underwent serial CEMRA with a minimum imaging follow-up of 11 months. Magnetic resonance imaging was performed at 1.5 T with electrocardiogram-gated, time-resolved CEMRA. Independent observers measured the diameter at the sinuses of Valsalva (SOVs) and mid ascending aorta (MAA) as well as ascending aorta volume between the aortic valve annulus and innominate branch. Intraobserver/interobserver coefficient of variation (COV) and intraclass correlation coefficient (ICC) were computed to assess reliability. Growth rates were calculated and assessed by Student t test (P < 0.05, significant). The diameter of maximal growth (DMG), defined as the diameter at SOV or MAA with the faster growth rate, was recorded.ResultsThe mean time of follow-up was 2.6 ± 0.82 years. The intraobserver COV was 0.01 for SOV, 0.02 for MAA, and 0.02 for volume (interobserver COV: 0.02, 0.03, 0.04, respectively). The ICC was 0.83 for SOV, 0.86 for MAA, 0.90 for DMG, and 0.95 for volume. Average aortic measurements at baseline and (follow-up) were 42 ± 3 mm (42 ± 3 mm, P = 0.11) at SOV, 46 ± 4 mm (47 ± 4 mm, P < 0.05) at MAA, and 130 ± 23 mL (144 ± 24 mL, P < 0.05). Average size changes were 0.2 ± 0.6 mm/y (1% ± 2%) at SOV, 0.5 ± 0.8 mm/y (1% ± 2%) at MAA, 0.7 ± 0.7 mm/y (2% ± 2%) at DMG, and 6 ± 3 mL/y (4% ± 3%) with volumetry.ConclusionsThree-dimensional CEMRA volumetry exhibited a larger effect when examining percentage growth, a better ICC, and a marginally lower COV. Volumetry may be more sensitive to growth and possibly less affected by error than diameter measurements.

Dataset Information

Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time.

Background

Method

Results

Conclusion

Publications

Aortic valve stenotic area calculation from phase contrast cardiovascular magnetic resonance: the importance of short echo time.

Similar Datasets

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