Fetal whole heart blood flow imaging using 4D cine MRI.
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ABSTRACT:
SUBMITTER: Roberts TA
PROVIDER: S-EPMC7116213 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
Publications
Fetal whole heart blood flow imaging using 4D cine MRI.
Roberts Thomas A TA van Amerom Joshua F P JFP Uus Alena A Lloyd David F A DFA van Poppel Milou P M MPM Price Anthony N AN Tournier Jacques-Donald JD Mohanadass Chloe A CA Jackson Laurence H LH Malik Shaihan J SJ Pushparajah Kuberan K Rutherford Mary A MA Razavi Reza R Deprez Maria M Hajnal Joseph V JV
Nature communications 20201005 1
Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in uter ...[more]
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Project description:Prenatal detection of congenital heart disease facilitates the opportunity for potentially life-saving care immediately after the baby is born. Echocardiography is routinely used for screening of morphological malformations, but functional measurements of blood flow are scarcely used in fetal echocardiography due to technical assumptions and issues of reliability. Magnetic resonance imaging (MRI) is readily used for quantification of abnormal blood flow in adult hearts, however, existing in utero approaches are compromised by spontaneous fetal motion. Here, we present and validate a novel method of MRI velocity-encoding combined with a motion-robust reconstruction framework for four-dimensional visualization and quantification of blood flow in the human fetal heart and major vessels. We demonstrate simultaneous 4D visualization of the anatomy and circulation, which we use to quantify flow rates through various major vessels. The framework introduced here could enable new clinical opportunities for assessment of the fetal cardiovascular system in both health and disease.
| S-EPMC7536221 | biostudies-literature
Project description:PurposeTo develop an MRI acquisition and reconstruction framework for volumetric cine visualization of the fetal heart and great vessels in the presence of maternal and fetal motion.MethodsFour-dimensional (4D) depiction was achieved using a highly-accelerated multi-planar real-time balanced steady-state free precession acquisition combined with retrospective image-domain techniques for motion correction, cardiac synchronization and outlier rejection. The framework was validated using a numerical phantom and evaluated in a study of 20 mid- to late-gestational age human fetal subjects (23-33 weeks gestational age). Reconstructed MR data were compared with matched ultrasound. A preliminary assessment of flow-sensitive reconstruction using the velocity information encoded in the phase of real-time images is included.ResultsReconstructed 4D data could be visualized in any two-dimensional plane without the need for highly specific scan plane prescription prior to acquisition or for maternal breath hold to minimize motion. Reconstruction was fully automated aside from user-specified masks of the fetal heart and chest. The framework proved robust when applied to fetal data and simulations confirmed that spatial and temporal features could be reliably recovered. Evaluation suggested the reconstructed framework has the potential to be used for comprehensive assessment of the fetal heart, either as an adjunct to ultrasound or in combination with other MRI techniques.ConclusionsThe proposed methods show promise as a framework for motion-compensated 4D assessment of the fetal heart and great vessels.
| S-EPMC6617816 | biostudies-literature
Project description:BackgroundRespiratory gating is generally recommended in 4D flow MRI of the heart to avoid blurring and motion artifacts. Recently, a novel automated contact-less camera-based respiratory motion sensor has been introduced.PurposeTo compare camera-based respiratory gating (CAM) with liver-lung-navigator-based gating (NAV) and no gating (NO) for whole-heart 4D flow MRI.Study typeRetrospective.SubjectsThirty two patients with a spectrum of cardiovascular diseases.Field strength/sequenceA 3T, 3D-cine spoiled-gradient-echo-T1-weighted-sequence with flow-encoding in three spatial directions.AssessmentRespiratory phases were derived and compared against each other by cross-correlation. Three radiologists/cardiologist scored images reconstructed with camera-based, navigator-based, and no respiratory gating with a 4-point Likert scale (qualitative analysis). Quantitative image quality analysis, in form of signal-to-noise ratio (SNR) and liver-lung-edge (LLE) for sharpness and quantitative flow analysis of the valves were performed semi-automatically.Statistical testsOne-way repeated measured analysis of variance (ANOVA) with Wilks's lambda testing and follow-up pairwise comparisons. Significance level of P ≤ 0.05. Krippendorff's-alpha-test for inter-rater reliability.ResultsThe respiratory signal analysis revealed that CAM and NAV phases were highly correlated (C = 0.93 ± 0.09, P < 0.01). Image scoring showed poor inter-rater reliability and no significant differences were observed (P ≥ 0.16). The image quality comparison showed that NAV and CAM were superior to NO with higher SNR (P = 0.02) and smaller LLE (P < 0.01). The quantitative flow analysis showed significant differences between the three respiratory-gated reconstructions in the tricuspid and pulmonary valves (P ≤ 0.05), but not in the mitral and aortic valves (P > 0.05). Pairwise comparisons showed that reconstructions without respiratory gating were different in flow measurements to either CAM or NAV or both, but no differences were found between CAM and NAV reconstructions.Data conclusionCamera-based respiratory gating performed as well as conventional liver-lung-navigator-based respiratory gating. Quantitative image quality analysis showed that both techniques were equivalent and superior to no-gating-reconstructions. Quantitative flow analysis revealed local flow differences (tricuspid/pulmonary valves) in images of no-gating-reconstructions, but no differences were found between images reconstructed with camera-based and navigator-based respiratory gating.Level of evidence3 TECHNICAL EFFICACY: Stage 2.
| S-EPMC8359364 | biostudies-literature
Project description:PurposeCurrent cardiovascular magnetic resonance (CMR) examinations require expert planning, multiple breath holds, and 2D imaging. To address this, we sought to develop and validate a comprehensive free-breathing 3D cine function and flow CMR examination using a steady-state free precession (SSFP) sequence to depict anatomy fused with a spatially registered phase contrast (PC) sequence for blood flow analysis.MethodsIn a prospective study, 25 patients underwent a CMR examination which included a 3D cine SSFP sequence and a 3D cine PC (also known as 4D flow) sequence acquired during free-breathing and after the administration of a gadolinium-based contrast agent. Both 3D sequences covered the heart and mediastinum, and used retrospective vectorcardiogram gating (20 phases/beat interpolated to 30 phases/beat) and prospective respiratory motion compensation confining data acquisition to end-expiration. Cardiovascular measurements derived from the 3D cine SSFP and PC images were then compared with those from standard 2D imaging.ResultsAll 3D cine SSFP and PC acquisitions were completed successfully. The mean time for the 3D cine sequences including prescription was shorter than that for the corresponding 2D sequences (21 min vs. 36 min, P-value <0.001). Left and right ventricular end-diastolic volumes and stroke volumes by 3D cine SSFP were slightly smaller than those from 2D cine SSFP (all biases ≤5%). The blood flow measurements from the 3D and 2D sequences had close agreement in the ascending aorta (bias -2.6%) but main pulmonary artery flow was lower with the 3D cine sequence (bias -11.2%).ConclusionCompared to the conventional 2D cine approach, a comprehensive 3D cine function and flow examination was faster and yielded slightly lower left and right end-diastolic volumes, stroke volumes, and main pulmonary artery blood flow. This free-breathing 3D cine approach allows flexible post-examination data analysis and has the potential to make examinations more comfortable for patients and easier to perform for the operator.
| S-EPMC7669675 | biostudies-literature
Project description:PurposeDevelopment of a MRI acquisition and reconstruction strategy to depict fetal cardiac anatomy in the presence of maternal and fetal motion.MethodsThe proposed strategy involves i) acquisition and reconstruction of highly accelerated dynamic MRI, followed by image-based ii) cardiac synchronization, iii) motion correction, iv) outlier rejection, and finally v) cardiac cine reconstruction. Postprocessing entirely was automated, aside from a user-defined region of interest delineating the fetal heart. The method was evaluated in 30 mid- to late gestational age singleton pregnancies scanned without maternal breath-hold.ResultsThe combination of complementary acquisition/reconstruction and correction/rejection steps in the pipeline served to improve the quality of the reconstructed 2D cine images, resulting in increased visibility of small, dynamic anatomical features. Artifact-free cine images successfully were produced in 36 of 39 acquired data sets; prolonged general fetal movements precluded processing of the remaining three data sets.ConclusionsThe proposed method shows promise as a motion-tolerant framework to enable further detail in MRI studies of the fetal heart and great vessels. Processing data in image-space allowed for spatial and temporal operations to be applied to the fetal heart in isolation, separate from extraneous changes elsewhere in the field of view. Magn Reson Med 79:327-338, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
| S-EPMC5763466 | biostudies-literature
Project description:We present an analysis of 3D blood flow in two cases of Sinus of Valsalva to right heart fistulae based on 4D flow MRI. Despite similar underlying pathology, 3D visualization revealed intricate differences in flow patterns connecting the systemic and pulmonary circulation. The cases illustrates the potential of 4D flow MRI to complement the evaluation of complex structural heart disease by assessing complex flow dynamics and providing quantitative information of flow ratios and flow rates.
| S-EPMC3770938 | biostudies-literature
Project description:Purpose To demonstrate the feasibility of four-dimensional (4D)-flow magnetic resonance (MR) imaging for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and Methods The institutional review board approved this prospective Health Insurance Portability and Accountability Act compliant study with written informed consent. Four-dimensional-flow MR imaging was performed in seven patients with portal hypertension and refractory ascites before and 2 and 12 weeks after TIPS placement by using a time-resolved three-dimensional radial phase-contrast acquisition. Flow and peak velocity measurements were obtained in the superior mesenteric vein (SMV), splenic vein (SV), portal vein (PV), and the TIPS. Flow volumes and peak velocities in each vessel, as well as the ratio of in-stent to PV flow, were compared before and after TIPS placement by using analysis of variance. Results Flow volumes significantly increased in the SMV (0.24 L/min; 95% confidence interval [CI]: 0.07, 0.41), SV (0.31 L/min; 95% CI: 0.07, 0.54), and PV (0.88 L/min; 95% CI: 0.06, 1.70) after TIPS placement (all P < .05), with no significant difference between the first and second post-TIPS placement acquisitions (all P > .11). Ascites resolved in six of seven patients. In those with resolved ascites, the TIPS-to-PV flow ratio was 0.8 ± 0.2 and 0.9 ± 0.2 at the two post-TIPS time points, respectively, while the observed ratios were 4.6 and 4.3 in the patient with refractory ascites at the two post-TIPS time points, respectively. In this patient, 4D-flow MR imaging demonstrated arterio-portal-venous shunting, with draining into the TIPS. Conclusion Four-dimensional-flow MR imaging is feasible for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after TIPS placement. © RSNA, 2016 Online supplemental material is available for this article.
| S-EPMC5069148 | biostudies-literature
Project description:BACKGROUND:Aortic remodeling after aortic valve replacement (AVR) might be influenced by the postoperative blood flow pattern in the ascending aorta. This pilot study used flow-sensitive four-dimensional magnetic resonance imaging (4D-flow) to describe ascending aortic flow characteristics after various types of AVR. METHODS:4D-flow was acquired in 38 AVR patients (n=9 mechanical, n=8 stentless bioprosthesis, n=14 stented bioprosthesis, n=7 autograft) and 9 healthy controls. Analysis included grading of vortex and helix flow (0-3 point scale), assessment of systolic flow eccentricity (1-3 point scale), and quantification of the segmental distribution of peak systolic wall shear stress (WSS(peak)) in the ascending aorta. RESULTS:Compared to controls, mechanical prostheses showed the most distinct vorticity (2.7±0.5 vs. 0.7±0.7; p<0.001), while stented bioprostheses exhibited most distinct helicity (2.6±0.7 vs. 1.6±0.5; p=0.002). Instead of a physiologic central flow, all stented, stentless and mechanical prostheses showed eccentric flow jets mainly directed towards the right-anterior aortic wall. Stented and stentless prostheses showed an asymmetric distribution of WSS(peak) along the aortic circumference, with significantly increased local WSS(peak) where the flow jet impinged on the aortic wall. Local WSS(peak) was higher in stented (1.4±0.7 N/m(2)) and stentless (1.3±0.7 N/m(2)) compared to autografts (0.6±0.2 N/m(2); p=0.005 and p=0.008) and controls (0.7±0.1 N/m(2); p=0.017 and p=0.027). Autografts exhibited lower absolute WSS(peak) than controls (0.4±0.1 N/m(2) vs. 0.7±0.2 N/m(2); p=0.003). CONCLUSIONS:Flow characteristics in the ascending aorta after AVR are different from native aortic valves and differ between various types of AVR.
| S-EPMC5099073 | biostudies-literature
Project description:IntroductionPhase contrast MRI allows for the examination of complex hemodynamics in the heart and adjacent great vessels. Vortex flow patterns seem to play an important role in certain vascular pathologies. We propose two- and three-dimensional metrics for the objective quantification of aortic vortex blood flow in 4D phase contrast MRI.Materials and methodsFor two-dimensional vorticity assessment, a standardized set of 6 regions-of-interest (ROIs) was defined throughout the course of the aorta. For each ROI, a heatmap of time-resolved vorticity values [Formula: see text] was computed. Evolution of minimum, maximum, and average values as well as opposing rotational flow components were analyzed. For three-dimensional analysis, vortex core detection was implemented combining the predictor-corrector method with λ2 correction. Strength, elongation, and radial expansion of the detected vortex core were recorded over time. All methods were applied to 4D flow MRI datasets of 9 healthy subjects, 2 patients with mildly dilated aorta, and 1 patient with aortic aneurysm.ResultsVorticity quantification in the 6 standardized ROIs enabled the description of physiological vortex flow in the healthy aorta. Helical flow developed early in the ascending aorta (absolute vorticity = 166.4±86.4 s-1 at 12% of cardiac cycle) followed by maximum values in mid-systole in the aortic arch (240.1±45.2 s-1 at 16%). Strength, elongation, and radial expansion of 3D vortex cores escalated in early systole, reaching a peak in mid systole (strength = 241.2±30.7 s-1 at 17%, elongation = 65.1±34.6 mm at 18%, expansion = 80.1±48.8 mm2 at 20%), before all three parameters similarly decreased to overall low values in diastole. Flow patterns were considerably altered in patient data: Vortex flow developed late in mid/end-systole close to the aortic bulb and no physiological helix was found in the aortic arch.ConclusionsWe have introduced objective measures for quantification of vortical flow in 4D phase contrast MRI. Vortex blood flow in the thoracic aorta could be consistently described in all healthy volunteers. In patient data, pathologically altered vortex flow was observed.
| S-EPMC4587936 | biostudies-literature
Project description:PurposeTo assess errors associated with EPI-accelerated intracardiac 4D flow MRI (4DEPI) with EPI factor 5, compared with non-EPI gradient echo (4DGRE).MethodsThree 3T MRI experiments were performed comparing 4DEPI to 4DGRE: steady flow through straight tubes, pulsatile flow in a left-ventricle phantom, and intracardiac flow in 10 healthy volunteers. For each experiment, 4DEPI was repeated with readout and blip phase-encoding gradient in different orientations, parallel or perpendicular to the flow direction. In vitro flow rates were compared with timed volumetric collection. In the left-ventricle phantom and in vivo, voxel-based speed and spatio-temporal median speed were compared between sequences, as well as mitral and aortic transvalvular net forward volume.ResultsIn steady-flow phantoms, the flow rate error was largest (12%) for high velocity (>2 m/s) with 4DEPI readout gradient parallel to the flow. Voxel-based speed and median speed in the left-ventricle phantom were ≤5.5% different between sequences. In vivo, mean net forward volume inconsistency was largest (6.4 ± 8.5%) for 4DEPI with nonblip phase-encoding gradient parallel to the main flow. The difference in median speed for 4DEPI versus 4DGRE was largest (9%) when the 4DEPI readout gradient was parallel to the flow.ConclusionsVelocity and flow rate are inaccurate for 4DEPI with EPI factor 5 when flow is parallel to the readout or blip phase-encoding gradient. However, mean differences in flow rate, voxel-based speed, and spatio-temporal median speed were acceptable (≤10%) when comparing 4DEPI to 4DGRE for intracardiac flow in healthy volunteers.
| S-EPMC9300143 | biostudies-literature