1. Whole-Heart 4D Flow MRI for Evaluation of Normal and Regurgitant Valvular Flow
- Author
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Bram F. Coolen, Jos J.M. Westenberg, Pim van Ooij, Carmen P.S. Blanken, Gustav J. Strijkers, Eva S. Peper, Aart J. Nederveen, R. Nils Planken, Lukas M. Gottwald, Graduate School, Radiology and Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, Amsterdam Neuroscience - Brain Imaging, Amsterdam Movement Sciences, Biomedical Engineering and Physics, ACS - Heart failure & arrhythmias, AMS - Musculoskeletal Health, AMS - Sports, and AMS - Ageing & Vitality
- Subjects
Intraclass correlation ,Population ,Imaging, Three-Dimensional ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,education ,Stroke ,compressed sensing reconstruction ,education.field_of_study ,medicine.diagnostic_test ,whole-heart 4D flow MRI ,business.industry ,Echo-Planar Imaging ,Repeated measures design ,Reproducibility of Results ,Magnetic resonance imaging ,Stroke Volume ,Blood flow ,medicine.disease ,Magnetic Resonance Imaging ,sparse sampling ,EPI readout ,valvular regurgitation ,Undersampling ,Ventricular Function, Right ,business ,Nuclear medicine ,Beat (music) ,Blood Flow Velocity - Abstract
Background Pseudo-spiral Cartesian sampling with compressed sensing reconstruction has facilitated highly accelerated 4D flow magnetic resonance imaging (MRI) in various cardiovascular structures. However, unlike echo planar imaging (EPI)-accelerated 4D flow MRI, it has not been validated in whole-heart applications. Hypothesis Pseudo-spiral 4D flow MRI (PROUD [PROspective Undersampling in multiple Dimensions]) is comparable to EPI in robustness of valvular flow measurements and remains comparable as the undersampling factor is increased and scan time reduced. Study Type Prospective. Population Twelve healthy subjects and eight patients with valvular regurgitation. Field Strength/Sequence 3.0 T; PROUD and EPI 4D flow sequences, 2D flow and balanced steady-state free precession sequences. Assessment Valvular blood flow was quantified using valve tracking. PROUD- and EPI-based measurements of aortic (AV) and pulmonary (PV) flow volumes and left and right ventricular stroke volumes were tested for agreement with 2D MRI-based measurements. PROUD reconstructions with undersampling factors (R) of 9, 14, 28, and 56 were tested for intervalve consistency (per valve, compared to the other valves) and preservation of peak velocities and E/A ratios. Statistical Tests We used repeated measures ANOVA, Bland-Altman, Wilcoxon signed rank, and intraclass correlation coefficients. P < 0.05 was considered statistically significant. Results PROUD and EPI intervalve consistencies were not significantly different both in healthy subjects (valve-averaged mean difference [limits of agreement width]: 3.2 +/- 0.8 [8.7 +/- 1.1] mL/beat for PROUD, 5.5 +/- 2.9 [13.7 +/- 2.3] mL/beat for EPI, P = 0.07) and in patients with valvular regurgitation (2.3 +/- 1.2 [15.3 +/- 5.9] mL/beat for PROUD, 0.6 +/- 0.6 [19.3 +/- 2.9] mL/beat for EPI, P = 0.47). Agreement between EPI and PROUD was higher than between 4D flow (EPI or PROUD) and 2D MRI for forward flow, stroke volumes, and regurgitant volumes. Up to R = 28 in healthy subjects and R = 14 in patients with valvular regurgitation, PROUD intervalve consistency remained comparable to that of EPI. Peak velocities and E/A ratios were preserved up to R = 9. Conclusion PROUD is comparable to EPI in terms of intervalve consistency and may be used with higher undersampling factors to shorten scan times further. Level of Evidence 1 Technical Efficacy Stage 2
- Published
- 2022