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Background: Thoracic and abdominal 4D flow MRI is typically acquired in combination with navigator respiration control which can result in highly variable scan efficiency (Seff) and thus total scan time due to inter-individual variability in breathing patterns. The aim of this study was to test the feasibility of an improved respiratory control strategy based on diaphragm navigator gating with fixed Seff, respiratory driven phase encoding, and a navigator training phase., Methods: 4D flow MRI of the thoracic aorta was performed in 10 healthy subjects at 1.5T and 3T systems for the in-vivo assessment of aortic time-resolved 3D blood flow velocities. For each subject, four 4D flow scans (1: conventional navigator gating, 2-4: new implementation with fixed Seff =60%, 80% and 100%) were acquired. Data analysis included semi-quantitative evaluation of image quality of the 4D flow magnitude images (image quality grading on a four point scale), 3D segmentation of the thoracic aorta, and voxel-by-voxel comparisons of systolic 3D flow velocity vector fields between scans., Results: Conventional navigator gating resulted in variable Seff=74±13% (range=56%-100%) due to inter-individual variability of respiration patterns. For scans 2-4, the new navigator implementation was able to achieve predictable total scan times with stable Seff, only depending on heart rate. Semi- and fully quantitative analysis of image quality in 4D flow magnitude images was similar for the new navigator scheme compared to conventional navigator gating. For aortic systolic 3D velocities, good agreement was found between all new navigator settings (scan 2-4) with the conventional navigator gating (scan 1) with best performance for Seff=80% (mean difference=-0.01 m/s; limits of agreement=0.23 m/s, Pearson's ρ=0.89, p<0.001). No significant differences for image quality or 3D systolic velocities were found for 1.5T compared to 3T., Conclusions: The findings of this study demonstrate the feasibility of the new navigator scheme to acquire 4D flow data with more predictable scan time while maintaining image quality and 3D velocity information, which may prove beneficial for clinical applications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To assess changes in portal and splanchnic arterial haemodynamics in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) using four-dimensional (4D) flow MRI, a non-invasive, non-contrast imaging technique., Methods: Eleven patients undergoing TIPS implantation were enrolled. K-t GRAPPA accelerated non-contrast 4D flow MRI of the liver vasculature was applied with acceleration factor R = 5 at 3Tesla. Flow analysis included three-dimensional (3D) blood flow visualization using time-resolved 3D particle traces and semi-quantitative flow pattern grading. Quantitative evaluation entailed peak velocities and net flows throughout the arterial and portal venous (PV) systems. MRI measurements were taken within 24 h before and 4 weeks after TIPS placement., Results: Three-dimensional flow visualization with 4D flow MRI revealed good image quality with minor limitations in PV flow. Quantitative analysis revealed a significant increase in PV flow (562 ± 373 ml/min before vs. 1831 ± 965 ml/min after TIPS), in the hepatic artery (176 ± 132 ml/min vs. 354 ± 140 ml/min) and combined flow in splenic and superior mesenteric arteries (770 ml/min vs. 1064 ml/min). Shunt-flow assessment demonstrated stenoses in two patients confirmed and treated at TIPS revision., Conclusions: Four-dimensional flow MRI might have the potential to give new information about the effect of TIPS placement on hepatic perfusion. It may explain some unexpected findings in clinical observation studies., Key Points: • 4D flow MRI, a non-invasive, non-contrast imaging technique, is feasible after TIPS. • Provides visualization and quantification of hepatic arterial, portal venous, collateral and TIPS haemodynamics. • Better understanding of liver blood flow changes after TIPS and patient management.

Objective: We sought to evaluate the feasibility of k-t parallel imaging for accelerated 4D flow MRI in the hepatic vascular system by investigating the impact of different acceleration factors., Materials and Methods: k-t GRAPPA accelerated 4D flow MRI of the liver vasculature was evaluated in 16 healthy volunteers at 3T with acceleration factors R = 3, R = 5, and R = 8 (2.0 × 2.5 × 2.4 mm(3), TR = 82 ms), and R = 5 (TR = 41 ms); GRAPPA R = 2 was used as the reference standard. Qualitative flow analysis included grading of 3D streamlines and time-resolved particle traces. Quantitative evaluation assessed velocities, net flow, and wall shear stress (WSS)., Results: Significant scan time savings were realized for all acceleration factors compared to standard GRAPPA R = 2 (21-71 %) (p < 0.001). Quantification of velocities and net flow offered similar results between k-t GRAPPA R = 3 and R = 5 compared to standard GRAPPA R = 2. Significantly increased leakage artifacts and noise were seen between standard GRAPPA R = 2 and k-t GRAPPA R = 8 (p < 0.001) with significant underestimation of peak velocities and WSS of up to 31 % in the hepatic arterial system (p <0.05). WSS was significantly underestimated up to 13 % in all vessels of the portal venous system for k-t GRAPPA R = 5, while significantly higher values were observed for the same acceleration with higher temporal resolution in two veins (p < 0.05)., Conclusion: k-t acceleration of 4D flow MRI is feasible for liver hemodynamic assessment with acceleration factors R = 3 and R = 5 resulting in a scan time reduction of at least 40 % with similar quantitation of liver hemodynamics compared with GRAPPA R = 2.

Purpose: The purpose of this study was to evaluate the utility of k-t parallel imaging for accelerating aortic four-dimensional (4D)-flow MRI. The aim was to systematically investigate the impact of different acceleration factors and number of coil elements on acquisition time, image quality and quantification of hemodynamic parameters., Methods: k-t accelerated 4D-flow MRI (spatial/temporal resolution = 2.1 × 2.5 × 2.5 mm/40.0 ms) was acquired in 10 healthy volunteers with acceleration factors R = 3, 5, and 8 using 12- and 32-channel receiver coils. Results were compared with conventional parallel imaging (GRAPPA [generalized autocalibrating partial parallel acquisition], R = 2). Data analysis included radiological grading of three-dimensional blood flow visualization quality as well as quantification of blood flow, velocities and wall shear stress (WSS)., Results: k-t GRAPPA significantly reduced scan time by 28%, 54%, and 68%, for R = 3, 5, and 8, respectively, while maintaining image quality as demonstrated by overall similar image quality grading. Significant differences in peak WSS (diff12ch = -5.9%, diff32ch = 18.5%) and mean WSS (diff32ch = 13.9%) were found at the descending aorta for both receiver coils for R = 5 (PWSS < 0.04). Peak velocity differed for R=8 at the aortic root (-7.4%) and descending aorta (-12%) with PpeakVelo < 0.03., Conclusion: k-t GRAPPA acceleration with a 12- or 32-channel receiver coil and an acceleration of 3 or 5 can compete with a standard GRAPPA R = 2 acceleration., (Copyright © 2013 Wiley Periodicals, Inc.)

Purpose: To evaluate influence of variation in spatio-temporal resolution and scan-rescan reproducibility on three-dimensional (3D) visualization and quantification of arterial and portal venous (PV) liver hemodynamics at four-dimensional (4D) flow MRI., Methods: Scan-rescan reproducibility of 3D hemodynamic analysis of the liver was evaluated in 10 healthy volunteers using 4D flow MRI at 3T with three different spatio-temporal resolutions (2.4 × 2.0 × 2.4 mm(3), 61.2 ms; 2.5 × 2.0 × 2.4 mm(3), 81.6 ms; 2.6 × 2.5 × 2.6 mm(3), 80 ms) and thus different total scan times. Qualitative flow analysis used 3D streamlines and time-resolved particle traces. Quantitative evaluation was based on maximum and mean velocities, flow volume, and vessel lumen area in the hepatic arterial and PV systems., Results: 4D flow MRI showed good interobserver variability for assessment of arterial and PV liver hemodynamics. 3D flow visualization revealed limitations for the left intrahepatic PV branch. Lower spatio-temporal resolution resulted in underestimation of arterial velocities (mean 15%, P < 0.05). For the PV system, hemodynamic analyses showed significant differences in the velocities for intrahepatic portal vein vessels (P < 0.05). Scan-rescan reproducibility was good except for flow volumes in the arterial system., Conclusion: 4D flow MRI for assessment of liver hemodynamics can be performed with low interobserver variability and good reproducibility. Higher spatio-temporal resolution is necessary for complete assessment of the hepatic blood flow required for clinical applications., (Copyright © 2013 Wiley Periodicals, Inc.)

Purpose: To evaluate spatiotemporal parallel imaging with R = 5 in comparison to conventional parallel imaging with R = 2 applied to phase contrast (PC) magnetic resonance imaging (MRI). This was motivated by the fact that scan times for PC imaging often exceed breath-hold capabilities of patients even with standard parallel imaging using typical reduction factors of R = 2., Materials and Methods: K-t generalized autocalibrating partially parallel acquisition (GRAPPA) acquisition was validated in phantom measurements and then applied in 10 volunteer and three patient examinations. Due to the higher reduction factor compared to conventional GRAPPA, k-t GRAPPA measurements could be performed during breath-hold with high spatial and temporal resolution. K-t GRAPPA scans were compared to GRAPPA acquired during free-breathing with navigator respiration control. In addition, spatiotemporally accelerated PC imaging was acquired during free-breathing for comparison of k-t-accelerated breath-held scans., Results: Substantial improvements in image quality for the breath-hold measurements were observed. Significantly reduced peak velocities were found for the GRAPPA protocol compared to the k-t-accelerated breath-hold scans for both flow (8%) and myocardial motion (up to 30%) measurements., Conclusion: Spatiotemporal acceleration allows the performance of high temporal or spatial resolution PC imaging during breath-hold while providing high image quality and robust acquisition of functional information that cannot be achieved during breath-hold with standard techniques., (Copyright © 2013 Wiley Periodicals, Inc.)

The aim of this study was to quantify changes in thoracic aortic wall shear stress (WSS) in asymptomatic patients with Marfan syndrome (MFS) compared with healthy controls. WSS in the thoracic aorta was quantified based on time-resolved 3D phase contrast MRI with three-directional velocity encoding (4D flow MRI, temporal resolution ∼44 ms, spatial resolution ∼2.5 mm) in 24 patients with confirmed MFS (age = 18 ± 12 years) and in 12 older healthy volunteers (age = 25 ± 3 years). Diameters of the thoracic aorta normalized to body surface area were similar for both groups. Peak systolic velocity, absolute WSS, time-averaged WSS, circumferential WSS, peak systolic WSS, and WSS eccentricity were calculated in eight analysis planes distributed along the thoracic aorta. Plane-wise comparison revealed significant differences between MFS patients and volunteers in the proximal ascending aorta for peak systolic velocities (1.11 ± 0.23 m/s vs. 1.34 ± 0.18 m/s, P = 0.004) and circumferential WSS (0.14 ± 0.03 N/m(2) vs. 0.11 ± 0.02 N/m(2), P = 0.007). WSS eccentricity was altered in most of the ascending aorta and proximal arch (P = 0.009-0.020). MFS patients demonstrated segmental differences in peak systolic WSS with a significantly higher WSS at the inner curvature in the proximal ascending aorta and at the anterior part in the more distal ascending aorta (P < 0.01). These findings indicate differences in WSS associated with MFS despite similar aortic dimensions compared to controls., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: The purpose of this study was to investigate 3D flow patterns and vessel wall parameters in patients with dilated ascending aorta, age-matched subjects, and healthy volunteers., Methods: Thoracic time-resolved 3D phase contrast CMR with 3-directional velocity encoding was applied to 33 patients with dilated ascending aorta (diameter≥40 mm, age=60±16 years), 15 age-matched normal controls (diameter≤37 mm, age=68±7.5 years) and 15 young healthy volunteers (diameter≤30 mm, age=23±2 years). 3D blood flow was visualized and flow patterns were graded regarding presence of supra-physiologic-helix and vortex flow using a semi-quantitative 3-point grading scale. Blood flow velocities, regional wall shear stress (WSS), and oscillatory shear index (OSI) were quantified., Results: Incidence and strength of supra-physiologic-helix and vortex flow in the ascending aorta (AAo) was significantly higher in patients with dilated AAo (16/33 and 31/33, grade 0.9±1.0 and 1.5±0.6) than in controls (2/15 and 7/15, grade 0.2±0.6 and 0.6±0.7, P<.05) or healthy volunteers (1/15 and 0/15, grade 0.1±0.3 P<.05). Greater strength of the ascending aortic helix and vortex flow were associated with significant differences in AAo diameters (P<.05). Peak systolic WSS in the ascending aorta and aortic arch was significantly lower in patients with dilated AAo (P<.0157-.0488). AAo diameter positively correlated to time to peak systolic velocities (r=0.30-0.53, P<.04), OSI (r=0.33-0.49, P<0.02) and inversely correlated to peak systolic WSS (r=0.32-0.40, P<.03). Peak systolic WSS was significantly lower in AAo aneurysms at the right and outer curvature within the AAo and proximal arch (P<.01-.05)., Conclusions: Increase in AAo diameter is significantly correlated with the presence and strength of supra-physiologic-helix and vortex formation in the AAo, as well with decrease in systolic WSS and increase in OSI.

This paper describes a clinically translatable interventional guidance platform to improve the accuracy and precision of stem cell injections into a beating heart. The proposed platform overlays live position of an injection catheter onto a fusion of a pre-procedural MR roadmap with real-time 3D transesophageal echocardiography (TEE). Electromagnetic (EM) tracking is used to initialize the fusion. The fusion is intra-operatively compensated for respiratory motion using a novel algorithm that uses peri-operative full volume ultrasound images. Validation of the system on a moving heart phantom produced a landmark registration accuracy of 2.8 +/- 1.45mm. Validation on animal in vivo data produced an average registration accuracy of 2.2 +/- 1.8 mm; indicating that it is feasible to reliably and robustly fuse the MR road-map with catheter position using 3D ultrasound in a clinical setting.