Fast Measurements of Flow Through Mitral Regurgitant Orifices With Magnetic Resonance Phase Velocity Mapping

Magnetic-resonance (MR) phase velocity mapping (PVM) shows promise in measuring the mitral regurgitant volume. However, in its conventional nonsegmented form, MR-PVM is slow and impractical for clinical use. The aim of this study was to evaluate the accuracy of rapid, segmented k-spaceMR-PVM in quantifying the mitral regurgitant flow through a control volume (CV) method. Two segmented MR-PVM schemes, one with seven (seg-7) and one with nine (seg-9) lines per segment, were evaluated in acrylic regurgitant mitral valve models under steady and pulsatile flow. A nonsegmented (nonseg) MR-PVM acquisition was also performed for reference. The segmented acquisitions were considerably faster (min) than the nonsegmented (\u3e45 min). The regurgitant flow rates and volumes measured with segmented MR-PVM agreed closely with those measured with nonsegmented MR-PVM (differences 0.05), when the CV was large enough to exclude the region of flow acceleration and aliasing from its boundaries. The regurgitant orifice shape (circular vs. slit-like) and the presence of aortic outflow did not significantly affect the accuracy of the results under both steady and pulsatile flow (p\u3e0.05). This study shows that segmented k-space MR-PVM canaccurately quantify the flow through regurgitant orifices using the CV method and demonstrates great clinical potential

Noninvasive Quantification of Fluid Mechanical Energy Losses in the Total Cavopulmonary Connection with Magnetic Resonance Phase Velocity Mapping

A major determinant of the success of surgical vascular modifications, such as the total cavopulmonary connection (TCPC), is the energetic efficiency that is assessed by calculating the mechanical energy loss of blood flow through the new connection. Currently, however, to determine the energy loss, invasive pressure measurements are necessary. Therefore, this study evaluated the feasibility of the viscous dissipation (VD) method, which has the potential to provide the energy loss without the need for invasive pressure measurements. Two experimental phantoms, a U-shaped tube and a glass TCPC, were scanned in a magnetic resonance (MR) imaging scanner and the images were used to construct computational models of both geometries. MR phase velocity mapping (PVM) acquisitions of all three spatial components of the fluid velocity were made in both phantoms and the VD was calculated. VD results from MR PVM experiments were compared with VD results from computational fluid dynamics (CFD) simulations on the image-based computational models. The results showed an overall agreement between MR PVM and CFD. There was a similar ascending tendency in the VD values as the image spatial resolution increased. The most accurate computations of the energy loss were achieved for a CFD grid density that was too high for MR to achieve under current MR system capabilities (in-plane pixel size of less than 0.4 mm). Nevertheless, the agreement between the MR PVM and the CFD VD results under the same resolution settings suggests that the VD method implemented with a clinical imaging modality such as MR has good potential to quantify the energy loss in vascular geometries such as the TCPC

Reliable In-Plane Velocity Measurements With Magnetic Resonance Velocity Imaging

Magnetic resonance (MR) imaging is a well-known diagnostic imaging modality. In addition to its high-quality imaging capabilities, hydrogen-based MR can also provide non-invasively the velocity of water-based fluids in all three spatial directions (through-plane and in-plane) in an image. Many previous studies showed that MR velocity imaging can accurately measure the through-plane velocity. The aim of this study was to evaluate how reliable are the in-plane velocity measurements in an image. The axial velocity of water in horizontal tubes (inner diameter: 14.7–26.2 mm) was measured with segmented (fast) and non-segmented (slow) k-space MR velocity imaging using: (a) an imaging slice placed perpendicular to the tube axis with through-plane velocity-encoding; and (b) an imaging slice placed parallel to the tube axis with in-plane velocity-encoding. The two planes intersected along the vertical tube-centerline. The flow rate was accurately quantified (mean error plane velocity profiles were not significantly different from the through-plane profiles (mean difference =6%, correlation coefficients \u3e0.98). There was no significant difference between the velocity profiles from the segmented and the non-segmented sequences (mean difference 0.95). The results of this study suggest that fast MR velocity imaging can measure the in-plane velocity in an image with reliability

Ultrafast Flow Quantification With Segmented K-Space Magnetic Resonance Phase Velocity Mapping

Magnetic resonance (MR) phase-velocity mapping (PVM) is routinely being used clinically to measure blood flow velocity. Conventional nonsegmented PVM is accurate but relatively slow (3–5 min per measurement). Ultrafast k-space segmented PVM offers much shorter acquisitions (on the order of seconds instead of minutes). The aim of this study was to evaluate the accuracy of segmented PVM in quantifying flow from through-plane velocity measurements. Experiments were performed using four straight tubes (inner diameter of 5.6–26.2 mm), under a variety of steady (1.7–200 ml/s) and pulsatile (6–90 ml/cycle) flow conditions. Two different segmented PVM schemes were tested, one with five k-space lines per segment and one with nine lines per segment. Results showed that both segmented sequences provided very accurate flow quantification (errorsflow conditions, even under turbulent flow conditions. This agreement was confirmed via regression analysis. Further statistical analysis comparing the flow data from the segmented PVM techniques with (i) the data from the nonsegmented technique and (ii) the true flow values showed no significant difference (all p values≫0.05). Preliminary flow measurements in the ascending aorta of two human subjects using the nonsegmented sequence and the segmented sequence with nine lines per segment showed very close agreement. The results of this study suggest that ultrafast PVM has great potential to measure blood velocity and quantify blood flow clinically. © 2002 Biomedical Engineering Society

Ultrafast Flow Quantification With Segmented K-Space Magnetic Resonance Phase Velocity Mapping

Magnetic resonance (MR) phase-velocity mapping (PVM) is routinely being used clinically to measure blood flow velocity. Conventional nonsegmented PVM is accurate but relatively slow (3–5 min per measurement). Ultrafast k-space segmented PVM offers much shorter acquisitions (on the order of seconds instead of minutes). The aim of this study was to evaluate the accuracy of segmented PVM in quantifying flow from through-plane velocity measurements. Experiments were performed using four straight tubes (inner diameter of 5.6–26.2 mm), under a variety of steady (1.7–200 ml/s) and pulsatile (6–90 ml/cycle) flow conditions. Two different segmented PVM schemes were tested, one with five k-space lines per segment and one with nine lines per segment. Results showed that both segmented sequences provided very accurate flow quantification (errorsflow conditions, even under turbulent flow conditions. This agreement was confirmed via regression analysis. Further statistical analysis comparing the flow data from the segmented PVM techniques with (i) the data from the nonsegmented technique and (ii) the true flow values showed no significant difference (all p values≫0.05). Preliminary flow measurements in the ascending aorta of two human subjects using the nonsegmented sequence and the segmented sequence with nine lines per segment showed very close agreement. The results of this study suggest that ultrafast PVM has great potential to measure blood velocity and quantify blood flow clinically. © 2002 Biomedical Engineering Society

Accurate Quantification of Steady and Pulsatile Flow With Segmented K-Space Magnetic Resonance Velocimetry

Conventional non-segmented magnetic resonance phase velocity mapping (MRPVM) is an accurate but relatively slow velocimetric technique. Therefore, the aim of this study was to evaluate the accuracy of the much faster segmented k-space MRPVM in quantifying flow. The axial velocity was measured in four straight tubes (inner diameter: 5.6–26.2 mm), using a segmented MRPVM sequence with seven lines of k-space per segment. The flow rate and flow volume were accurately quantified (errorssteady (r2=0.99) and pulsatile flow (r2=0.98), respectively. The measured velocity profiles and flow rates from the segmented sequence agreed with those from the non-segmented (p\u3e0.05). Changing the slice thickness or the field of view did not affect the accuracy of the measurements. The results of this study suggest that fast, segmented MRPVM can be used for accurate flow quantification

Accurate Quantification of Steady and Pulsatile Flow With Segmented K-Space Magnetic Resonance Velocimetry

Conventional non-segmented magnetic resonance phase velocity mapping (MRPVM) is an accurate but relatively slow velocimetric technique. Therefore, the aim of this study was to evaluate the accuracy of the much faster segmented k-space MRPVM in quantifying flow. The axial velocity was measured in four straight tubes (inner diameter: 5.6–26.2 mm), using a segmented MRPVM sequence with seven lines of k-space per segment. The flow rate and flow volume were accurately quantified (errorssteady (r2=0.99) and pulsatile flow (r2=0.98), respectively. The measured velocity profiles and flow rates from the segmented sequence agreed with those from the non-segmented (p\u3e0.05). Changing the slice thickness or the field of view did not affect the accuracy of the measurements. The results of this study suggest that fast, segmented MRPVM can be used for accurate flow quantification

Clinical Blood Flow Quantification with Segmented k-Space Magnetic Resonance Phase Velocity Mapping

To evaluate the accuracy of segmented k-space magnetic resonance phase velocity mapping (PVM) in quantifying aortic blood flow from through-plane velocity measurements. Two segmented PVM schemes were evaluated, one with seven lines per segment (seg-7) and one with nine lines per segment (seg-9), in twenty patients with cardiovascular disease. A non-segmented (non-seg) PVM acquisition was also performed to provide the reference data. There was agreement between the aortic flow curves acquired with segmented and non-segmented PVM. The calculated systolic and total flow volume per cycle from the seg-7 and the seg-9 scans correlated and agreed with the flow volumes from the non-seg scans (differences \u3c 5%). Sign tests showed that there were no statistically significant differences (P-values \u3c 0.05) between the segmented and the non-segmented PVM measurements. Seg-9, which was the fastest among the three sequences, provided adequate spatial and temporal resolution (\u3e 10 phases per cycle)

Extent of Thoracic Aortic Atheroma Burden and Long-Term Mortality After Cardiothoracic Surgery A Computed Tomography Study

ObjectivesWe hypothesized that the extent of aortic atheroma of the entire thoracic aorta, determined by pre-operative multidetector-row computed tomographic angiography (MDCTA), is associated with long-term mortality following nonaortic cardiothoracic surgery.BackgroundIn patients evaluated for cardiothoracic surgery, presence of severe aortic atheroma is associated with adverse short- and long-term post-operative outcome. However, the relationship between aortic plaque burden and mortality remains unknown.MethodsWe reviewed clinical and imaging data from all patients who underwent electrocardiographic-gated contrast-enhanced MDCTA prior to coronary bypass or valvular heart surgery at our institution between 2002 and 2008. MDCTA studies were analyzed for thickness and circumferential extent of aortic atheroma in 5 segments of the thoracic aorta. A semiquantitative total plaque-burden score (TPBS) was calculated by assigning a score of 1 to 3 to plaque thickness and to circumferential plaque extent. When combined, this resulted in a score of 0 to 6 for each of the 5 segments and, hence, an overall score from 0 to 30. The primary end point was all-cause mortality during long-term follow-up.ResultsA total of 862 patients (71% men, 67.8 years) were included and followed over a mean period of 25 ± 16 months. The mean TPBS was 8.6 (SD: ±6.0). The TPBS was a statistically significant predictor of mortality (p < 0.0001) while controlling for baseline demographics, cardiovascular risk factors, and type of surgery including reoperative status. The estimated hazard ratio for TPBS was 1.08 (95% confidence interval: 1.045 to 1.12). Other independent predictors of mortality were glomerular filtration rate (p = 0.015), type of surgery (p = 0.007), and peripheral artery disease (p = 0.03).ConclusionsExtent of thoracic aortic atheroma burden is independently associated with increased long-term mortality in patients following cardiothoracic surgery. Although our data do not provide definitive evidence, they suggest a relationship to the systemic atherosclerotic disease process and, therefore, have important implications for secondary prevention in post-operative rehabilitation programs

Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging

Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed