Abnormal Blood Flow Dynamics Assessed with 4D Flow MRI Are Associated with Shape and Torsion of the Reconstructed Aortic Arch in Patients with Hypoplastic Left Heart Syndrome after Palliation

Abstract Background Mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM) has different blood flow dynamics from other phenotypes, but there are few detailed data on blood flow dynamics in the left ventricle. Methods 4D-Flow MRI were performed at 1.5 T or 3 T with 9 MVO-HCM patients and 22 control patients (LVEF>50%, no wall motion abnormality). Myocardial infarction, severe valvular disease, HCM cases other than MVO were excluded. We calculated the cardiac function parameters and observed blood flow dynamics in the left ventricle using 4D-Flow MRI. Results LV mass was significantly higher in MVO-HCM group than in Control group (Control group; 73.3g vs MVO-HCM group; 109.5g, P=0.019). LVEF was higher in MVO-HCM group (Control group; 61.6% vs MVO-HCM group; 70.6%, P=0.026), but Stroke volume did not differ between the two groups (Control group; 68.8ml vs MVO-HCM group; 64.4ml, P=0.43).One or two vortices were observed in the left ventricle after opening the mitral valve. Two vortices were observed in 16 cases (72.7%) in the control group and 9 cases (100%) in the MVO-HCM group. Two vortices were formed on the anterior side and the posterior side. Blood flow pattern in which the vortex on the posterior side was formed to be the same size or larger than the vortex on the anterior side was observed only in the MVO-HCM group (Control group; 0% vs MVO-HCM group; 66.7%, P<0.001). Streamline of MVO-HCM & Control Conclusion Characteristic blood flow patterns in the left ventricle of the MVO-HCM were revealed by using 4D-MRI. We thought that blood flow collides with the left ventricle wall due to the marked hypertrophy in the mid-ventricle, and normal vortex ring can not be formed in the MVO-HCM cases.

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Associations between haemodynamics and wall enhancement of intracranial aneurysm

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000636 ◽

2021 ◽

pp. svn-2020-000636

Author(s):

Miaoqi Zhang ◽

Fei Peng ◽

Xin Tong ◽

Xin Feng ◽

Yunduo Li ◽

...

Keyword(s):

Blood Flow ◽

High Resolution ◽

Ordinal Regression ◽

Parent Artery ◽

Black Blood ◽

4D Flow Mri ◽

4D Flow ◽

Unruptured Intracranial Aneurysms ◽

Black Blood Mri ◽

Flow Mri

Background and purposePrevious studies have reported about inflammation processes (IPs) that play important roles in aneurysm formation and rupture, which could be driven by blood flow. IPs can be identified using aneurysmal wall enhancement (AWE) on high-resolution black-blood MRI (BB-MRI) and blood flow haemodynamics can be demonstrated by four-dimensional-flow MRI (4D-flow MRI). Thus, this study investigated the associations between AWE and haemodynamics in unruptured intracranial aneurysms (IA) by combining 4D-flow MRI and high-resolution BB-MRI.Materials and methodsBetween April 2014 and October 2017, 48 patients with 49 unruptured IA who underwent both 4D-flow MRI and high-resolution BB-MRI were retrospectively included in this study. The haemodynamic parameters demonstrated using 4D-flow MRI were compared between different AWE patterns using the Kruskal-Wallis test and ordinal regression.ResultsThe results of Kruskal-Wallis test showed that the average wall shear stress in the IA (WSSavg-IA), maximum through-plane velocity in the adjacent parent artery, inflow jet patterns and the average vorticity in IA (vorticityavg-IA) were significantly associated with the AWE patterns. Ordinal regression analysis identified WSSavg-IA (p=0.002) and vorticityavg-IA (p=0.033) as independent predictors of AWE patterns.ConclusionA low WSS and low average vorticity were independently associated with a high AWE grade for IAs larger than 4 mm. Therefore, WSS and average vorticity could predict AWE and circumferential AWE.

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A pilot study investigating the use of 4D flow MRI for the assessment of splanchnic flow in patients suspected of mesenteric ischaemia

Scientific Reports ◽

10.1038/s41598-021-85315-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pauline Hall Barrientos ◽

Katrina Knight ◽

Douglas Black ◽

Alexander Vesey ◽

Giles Roditi

Keyword(s):

Blood Flow ◽

Pilot Study ◽

Splenic Vein ◽

Normal Subjects ◽

Mesenteric Ischaemia ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri ◽

Mesenteric Vessels ◽

Flow Changes

AbstractThe most common cause of chronic mesenteric ischaemia is atherosclerosis which results in limitation of blood flow to the gastrointestinal tract. This pilot study aimed to evaluate 4D flow MRI as a potential tool for the analysis of blood flow changes post-prandial within the mesenteric vessels. The mesenteric vessels of twelve people were scanned; patients and healthy volunteers. A baseline MRI scan was performed after 6 h of fasting followed by a post-meal scan. Two 4D flow datasets were acquired, over the superior mesenteric artery (SMA) and the main portal venous vessels. Standard 2D time-resolved PC-MRI slices were also obtained across the aorta above the coeliac trunk, superior mesenteric vein, splenic vein and portal vein (PV). In the volunteer cohort there was a marked increase in blood flow post-meal within the PV (p = 0.028), not seen in the patient cohort (p = 0.116). Similarly, there were significant flow changes within the SMA of volunteers (p = 0.028) but not for the patient group (p = 0.116). Our pilot data has shown that there is a significant haemodynamic response to meal challenge in the PV and SMA in normal subjects compared to clinically apparent CMI patients. Therefore, the interrogation of mesenteric venous vessels exclusively is a feasible method to measure post-prandial flow changes in CMI patients.

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Four-Dimensional Flow MRI of Abdominal Veins: A Systematic Review

Diagnostics ◽

10.3390/diagnostics11050767 ◽

2021 ◽

Vol 11 (5) ◽

pp. 767

Author(s):

Simon O. Haarbye ◽

Michael B. Nielsen ◽

Adam E. Hansen ◽

Carsten A. Lauridsen

Keyword(s):

Systematic Review ◽

Blood Flow ◽

Portal Hypertension ◽

Healthy Subjects ◽

Visual Quality ◽

Sampling Strategies ◽

4D Flow Mri ◽

4D Flow ◽

Dimensional Flow ◽

Flow Mri

The aim of this systematic review is to provide an overview of the use of Four-Dimensional Magnetic Resonance Imaging of vector blood flow (4D Flow MRI) in the abdominal veins. This study was composed according to the PRISMA guidelines 2009. The literature search was conducted in MEDLINE, Cochrane Library, EMBASE, and Web of Science. Quality assessment of the included studies was performed using the QUADAS-2 tool. The initial search yielded 781 studies and 21 studies were included. All studies successfully applied 4D Flow MRI in abdominal veins. Four-Dimensional Flow MRI was capable of discerning between healthy subjects and patients with cirrhosis and/or portal hypertension. The visual quality and inter-observer agreement of 4D Flow MRI were rated as excellent and good to excellent, respectively, and the studies utilized several different MRI data sampling strategies. By applying spiral sampling with compressed sensing to 4D Flow MRI, the blood flow of several abdominal veins could be imaged simultaneously in 18–25 s, without a significant loss of visual quality. Four-Dimensional Flow MRI might be a useful alternative to Doppler sonography for the diagnosis of cirrhosis and portal hypertension. Further clinical studies need to establish consensus regarding MRI sampling strategies in patients and healthy subjects.

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4D flow MRI—Automatic assessment of blood flow in cerebral arteries

Biomedical Physics & Engineering Express ◽

10.1088/2057-1976/aae8d1 ◽

2018 ◽

Vol 5 (1) ◽

pp. 015003

Author(s):

Tora Dunås ◽

Anders Wåhlin ◽

Laleh Zarrinkoob ◽

Jan Malm ◽

Anders Eklund

Keyword(s):

Blood Flow ◽

Cerebral Arteries ◽

Automatic Assessment ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri

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Frequent Dilatation of the Descending Aorta in Children With Hypoplastic Left Heart Syndrome Relates to Decreased Aortic Arch Elasticity

Journal of the American Heart Association ◽

10.1161/jaha.115.002107 ◽

2015 ◽

Vol 4 (10) ◽

Cited By ~ 7

Author(s):

Inga Voges ◽

Michael Jerosch‐Herold ◽

Philip Wegner ◽

Christopher Hart ◽

Dominik Gabbert ◽

...

Keyword(s):

Aortic Arch ◽

Hypoplastic Left Heart Syndrome ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Descending Aorta ◽

Left Heart Syndrome

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P3-290: Reduced Middle Cerebral Artery Blood Flow is Associated with Decrements in Executive Functioning, Attention, and Verbal Learning and Memory in Aging Individuals with Heart Failure: a 4D Flow Mri Study

Alzheimer s & Dementia ◽

10.1016/j.jalz.2016.06.1954 ◽

2016 ◽

Vol 12 ◽

pp. P950-P952 ◽

Cited By ~ 3

Author(s):

Kelsey E. Melah ◽

Brianna Jankowski ◽

Chooza Moon ◽

Leonardo A. Rivera ◽

Oliver Wieben ◽

...

Keyword(s):

Heart Failure ◽

Blood Flow ◽

Executive Functioning ◽

Middle Cerebral Artery ◽

Verbal Learning ◽

Artery Blood Flow ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri ◽

Mri Study

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Abstract 19315: Geometry, Reintervention, and Growth Patterns in the Reconstructed Aortic Arch With Interdigitating Technique in Patients With Hypoplastic Left Heart Syndrome and Variants

Circulation ◽

10.1161/circ.132.suppl_3.19315 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Christoph Haller ◽

Devin Chetan ◽

Matthew Doyle ◽

Arezou Saedi ◽

Rachel Parker ◽

...

Keyword(s):

Aortic Arch ◽

Ventricular Function ◽

Hypoplastic Left Heart Syndrome ◽

Growth Characteristics ◽

Stage Ii ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Z Scores ◽

Arch Reconstruction ◽

Left Heart Syndrome

Objectives: The interdigitating technique in aortic arch reconstruction in hypoplastic left heart syndrome and variants (HLHS) is very effective to minimize the recoarctation rate. Little is known on the aortic arch’s growth characteristics and the resulting clinical impact. Methods: 139 patients with HLHS underwent staged palliation between 2007 and 2014. 72 patients who underwent Norwood arch reconstruction with the interdigitating technique were included. Dimensions of the ascending aorta (AA), transverse arch (TA), isthmus (IA) and descending aorta (DA) in pre-stage II (P1, n=50) and pre-Fontan (P2, n=21) angiograms were measured and geometry and growth characteristics of the aortic arches were analyzed. Correlations between the aortic dimensions and clinical outcomes were assessed. Results: There were significant increases in diameters in all segments between P1 and P2 (p < .0005). The z-scores in AA, TA and IA were unchanged between P1 and P2 (p = .931/.425/.121), but increased significantly in DA at P2 (p = .039). The percent increase in diameters were comparable among 4 segments (mean, 146% in IA, 144 in DA, p=.648). There were correlations in dimensions and z-scores between P1 and P2 in AA (p = .029/.013) and TA (p = .001/ < .0005), but no correlations were found in IA (p = .140/.747) and DA (p = .075/.432). The most significant tapering in the arch dimension occurred between TA and IA in both time points (P1, 67.3% vs. P2, 61.1%, p=.303). The reverse coarctation index (TA/IA ratio) at P1 (r = .381, p = .042), but not coarctation index (CoAI, IA/DA ratio) at P1 (p = .774) had a significant correlation with post-stage II ventricular function. Balloon dilatation for recoarctation was needed in 2 (2.7%) patients prior to stage II palliation. CoAI at P1 was a predictor for ventricular dysfunction at latest follow-up (p=.017). Conclusions: Aortic arch growth after interdigitating reconstruction in HLHS is substantial and relatively constant. The isthmus growth is proportional to other segments. Overall reintervention rate for recoarctation is exceptionally low. CoAI prior to stage II palliation may be associated with long-term ventricular function.

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