Jelena Bock

Quantitative 2D and 3D phase contrast MRI: Optimized analysis of blood flow and vessel wall parameters

Quantification of CINE phase contrast (PC)‐MRI data is a challenging task because of the limited spatiotemporal resolution and signal‐to‐noise ratio (SNR). The method presented in this work combines B‐spline interpolation and Greens theorem to provide optimized quantification of blood flow and vessel wall parameters. The B‐spline model provided optimal derivatives of the measured three‐directional blood velocities onto the vessel contour, as required for vectorial wall shear stress (WSS) computation. Eight planes distributed along the entire thoracic aorta were evaluated in a 19‐volunteer study using both high‐spatiotemporal‐resolution planar two‐dimensional (2D)‐CINE‐PC (∼1.4 × 1.4 mm2/24.4 ms) and lower‐resolution 3D‐CINE‐PC (∼2.8 × 1.6 × 3 mm3/48.6 ms) with three‐directional velocity encoding. Synthetic data, error propagation, and interindividual, intermodality, and interobserver variability were used to evaluate the reliability and reproducibility of the method. While the impact of MR measurement noise was only minor, the limited resolution of PC‐MRI introduced systematic WSS underestimations. In vivo data demonstrated close agreement for flow and WSS between 2D‐ and 3D‐CINE‐PC as well as observers, and confirmed the reliability of the method. WSS analysis along the aorta revealed the presence of a circumferential WSS component accounting for 10–20%. Initial results in a patient with atherosclerosis suggest the potential of the method for understanding the formation and progression of cardiovascular diseases. Magn Reson Med 60:1218–1231, 2008.

Three-dimensional analysis of segmental wall shear stress in the aorta by flow-sensitive four-dimensional-MRI

To assess the distribution and regional differences of flow and vessel wall parameters such as wall shear stress (WSS) and oscillatory shear index (OSI) in the entire thoracic aorta.

3D blood flow characteristics in the carotid artery bifurcation assessed by flow-sensitive 4D MRI at 3T

To determine three‐dimensional (3D) blood flow patterns in the carotid bifurcation, 10 healthy volunteers and nine patients with internal carotid artery (ICA) stenosis ≥50% were examined by flow‐sensitive 4D MRI at 3T. Absolute and mean blood velocities, pulsatility index (PI), and resistance index (RI) were measured in the common carotid arteries (CCAs) by duplex sonography (DS) and compared with flow‐sensitive 4D MRI. Furthermore, 3D MRI blood flow patterns in the carotid bifurcation of volunteers and patients before and after recanalization were graded by two independent readers. Blood flow velocities measured by MRI were 31–39% lower than in DS. However, PI and RI differed by only 13–16%. Rating of 3D flow characteristics in the ICA revealed consistent patterns for filling and helical flow in volunteers. In patients with ICA stenosis, 3D blood flow visualization was successfully employed to detect markedly altered filling and helical flow patterns (forward‐moving spiral flow) in the ICA bulb and to evaluate the effect of revascularization, which restored filling and helical flow. Our results demonstrate the feasibility of flow‐sensitive 4D MRI for the quantification and 3D visualization of physiological and pathological flow patterns in the carotid artery bifurcation. Magn Reson Med 61:65–74, 2009.

4D phase contrast MRI at 3 T: effect of standard and blood-pool contrast agents on SNR, PC-MRA, and blood flow visualization.

Time‐resolved phase contrast (PC) MRI with velocity encoding in three directions (flow‐sensitive four‐dimensional MRI) can be employed to assess three‐dimensional blood flow in the entire aortic lumen within a single measurement. These data can be used not only for the visualization of blood flow but also to derive additional information on vascular geometry with three‐dimensional PC MR angiography (MRA). As PC‐MRA is sensitive to available signal‐to‐noise ratio, standard and novel blood pool contrast agents may help to enhance PC‐MRA image quality. In a group of 30 healthy volunteers, the influence of different contrast agents on vascular signal‐to‐noise ratio, PC‐MRA quality, and subsequent three‐dimensional stream‐line visualization in the thoracic aorta was determined. Flow‐sensitive four‐dimensional MRI data acquired with contrast agent provided significantly improved signal‐to‐noise ratio in magnitude data and noise reduction in velocity data compared to measurements without contrast media. The agreement of three‐dimensional PC‐MRA with reference standard contrast‐enhanced MRA was good for both contrast agents, with improved PC‐MRA performance for blood pool contrast agent, particularly for the smaller supra‐aortic branches. For three‐dimensional flow visualization, a trend toward improved results for the data with contrast agent was observed. Magn Reson Med, 2010.

3D MR flow analysis in realistic rapid-prototyping model systems of the thoracic aorta: Comparison with in vivo data and computational fluid dynamics in identical vessel geometries

The knowledge of local vascular anatomy and function in the human body is of high interest for the diagnosis and treatment of cardiovascular disease. A comprehensive analysis of the hemodynamics in the thoracic aorta is presented based on the integration of flow‐sensitive 4D MRI with state‐of‐the‐art rapid prototyping technology and computational fluid dynamics (CFD). Rapid prototyping was used to transform aortic geometries as measured by contrast‐enhanced MR angiography into realistic vascular models with large anatomical coverage. Integration into a flow circuit with patient‐specific pulsatile in‐flow conditions and application of flow‐sensitive 4D MRI permitted detailed analysis of local and global 3D flow dynamics in a realistic vascular geometry. Visualization of characteristic 3D flow patterns and quantitative comparisons of the in vitro experiments with in vivo data and CFD simulations in identical vascular geometries were performed to evaluate the accuracy of vascular model systems. The results indicate the potential of such patient‐specific model systems for detailed experimental simulation of realistic vascular hemodynamics. Further studies are warranted to examine the influence of refined boundary conditions of the human circulatory system such as fluid‐wall interaction and their effect on normal and pathological blood flow characteristics associated with vascular geometry. Magn Reson Med 59:535–546, 2008.

Retrograde Embolism From the Descending Aorta. Visualization by Multidirectional 3D Velocity Mapping in Cryptogenic Stroke

Background and Purpose— The purpose of this study was to determine the role of plaques ≥4 mm and thrombi (complex plaques) in the descending aorta (DAo) as an embolic high-risk source for stroke. Methods— In 63 acute stroke patients scheduled for TEE, territory and embolic pattern of brain ischemia were prospectively assessed. Multidirectional 3D MRI velocity mapping of the aorta was performed to correlate the extent of retrograde diastolic blood flow with the distance of complex DAo plaques from the left subclavian artery (LSA). Embolic risk from the DAo was present for (1) retrograde flow connecting complex DAo plaques with the LSA, (2) embolic pattern of brain ischemia in a territory supplied by the left vertebral artery, and (3) stroke that could not be explained by other means. Results— 33 of 63 patients had complex DAo plaques (distance to LSA 28.1±29.9 mm). Mean retrograde flow in these subjects was 26.2±12.3 mm. In 20 of 63 patients (31.7%) retrograde flow connected complex DAo plaques with the LSA. In 4 of these 20 patients (20%) with an embolic stroke in the territory of the brain stem, cerebellum or posterior cerebral artery, etiology could not be explained by other means. Conclusions— Substantial diastolic retrograde flow originating from complex plaques in the descending aorta was detected by multidirectional 3D MRI velocity mapping and constitutes a stroke mechanism that was previously not demonstrable.

In vivo noninvasive 4D pressure difference mapping in the human aorta: Phantom comparison and application in healthy volunteers and patients†

In this work, we present a systematic phantom comparison and clinical application of noninvasive pressure difference mapping in the human aorta based on time‐resolved 3D phase contrast data. Relative pressure differences were calculated based on integration and iterative refinement of pressure gradients derived from MR‐based three‐directional velocity vector fields (flow‐sensitive 4D MRI with spatial/temporal resolution ∼ 2.1 mm3/40 ms) using the Navier‐Stokes equation. After in vitro study using a stenosis phantom, time‐resolved 3D pressure gradients were systematically evaluated in the thoracic aorta in a group of 12 healthy subjects and 6 patients after repair for aortic coarctation. Results from the phantom study showed good agreement with expected values and standard methods (Bernoulli). Data of healthy subjects showed good intersubject consistency and good agreement with the literature. In patients, pressure waveforms showed elevated peak values. Pressure gradients across the stenosis were compared with reference measurements from Doppler ultrasound. The MRI findings demonstrated a significant correlation (r = 0.96, P < 0.05) but moderate underestimation (14.7% ± 15.5%) compared with ultrasound when the maximum pressure difference for all possible paths connecting proximal and distal locations of the stenosis were used. This study demonstrates the potential of the applied approach to derive additional quantitative information such as pressure gradients from time‐resolved 3D phase contrast MRI. Magn Reson Med, 2011.

4D flow magnetic resonance imaging in bicuspid aortic valve disease demonstrates altered distribution of aortic blood flow helicity.

Changes in aortic geometry or presence of aortic valve (AoV) disease can result in substantially altered aortic hemodynamics. Dilatation of the ascending aorta or AoV abnormalities can result in an increase in helical flow.

A finite-element approach to the direct computation of relative cardiovascular pressure from time-resolved MR velocity data

Graphical abstract Highlights ► Extraction of relative pressure from 4D MRI data sets. ► A novel workflow for determining relative cardiovascular pressure fields. ► Demonstration of the approach across a range of validation examples. ► Four subject specific cases showing agreement with published pressure differences.

Fast interactive exploration of 4D MRI flow data

1- or 2-directional MRI blood flow mapping sequences are an integral part of standard MR protocols for diagnosis and therapy control in heart diseases. Recent progress in rapid MRI has made it possible to acquire volumetric, 3-directional cine images in reasonable scan time. In addition to flow and velocity measurements relative to arbitrarily oriented image planes, the analysis of 3-dimensional trajectories enables the visualization of flow patterns, local features of flow trajectories or possible paths into specific regions. The anatomical and functional information allows for advanced hemodynamic analysis in different application areas like stroke risk assessment, congenital and acquired heart disease, aneurysms or abdominal collaterals and cranial blood flow. The complexity of the 4D MRI flow datasets and the flow related image analysis tasks makes the development of fast comprehensive data exploration software for advanced flow analysis a challenging task. Most existing tools address only individual aspects of the analysis pipeline such as pre-processing, quantification or visualization, or are difficult to use for clinicians. The goal of the presented work is to provide a software solution that supports the whole image analysis pipeline and enables data exploration with fast intuitive interaction and visualization methods. The implemented methods facilitate the segmentation and inspection of different vascular systems. Arbitrary 2- or 3-dimensional regions for quantitative analysis and particle tracing can be defined interactively. Synchronized views of animated 3D path lines, 2D velocity or flow overlays and flow curves offer a detailed insight into local hemodynamics. The application of the analysis pipeline is shown for 6 cases from clinical practice, illustrating the usefulness for different clinical questions. Initial user tests show that the software is intuitive to learn and even inexperienced users achieve good results within reasonable processing times.