Mitral regurgitation quantification by cardiac magnetic resonance imaging (MRI) remains reproducible between software solutions

Background: The reproducibility of mitral regurgitation (MR) quantification by cardiovascular magnetic resonance (CMR) imaging using different software solutions remains unclear. This research aimed to investigate the reproducibility of MR quantification between two software solutions: MASS (version 2019 EXP, LUMC, Netherlands) and CAAS (version 5.2, Pie Medical Imaging). Methods: CMR data of 35 patients with MR (12 primary MR, 13 mitral valve repair/replacement, and ten secondary MR) was used. Four methods of MR volume quantification were studied, including two 4D-flow CMR methods (MRMVAV and MRJet) and two non-4D-flow techniques (MRStandard and MRLVRV). We conducted within-software and inter-software correlation and agreement analyses. Results: All methods demonstrated significant correlation between the two software solutions: MRStandard (r=0.92, p<0.001), MRLVRV (r=0.95, p<0.001), MRJet (r=0.86, p<0.001), and MRMVAV (r=0.91, p<0.001). Between CAAS and MASS, MRJet and MRMVAV, compared to each of the four methods, were the only methods not to be associated with significant bias. Conclusions: We conclude that 4D-flow CMR methods demonstrate equivalent reproducibility to non-4D-flow methods but greater levels of agreement between software solutions.

Download Full-text

Changes of Wall Shear Stress after Congenital Aortic Valve Repair Measured by 4D Flow Cardiovascular Magnetic Resonance Imaging

10.1055/s-0040-1705371 ◽

2020 ◽

Author(s):

J. Petersen ◽

A. Lenz ◽

G. Adam ◽

H. Reichenspurner ◽

P. Bannas ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Shear Stress ◽

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Valve ◽

Wall Shear Stress ◽

Cardiovascular Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Valve Repair ◽

4D Flow

Download Full-text

P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography

European Heart Journal ◽

10.1093/eurheartj/ehz747.0196 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Ribeyrolles ◽

J L Monin ◽

A Rohnean ◽

C Diakov ◽

C Caussin ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Stroke Volume ◽

Left Ventricular ◽

Left Ventricular Stroke Volume ◽

4D Flow ◽

Mitral Flow ◽

4D Flow Cmr ◽

Mr Quantification ◽

Cine Cmr

Abstract Background Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification. Purpose Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach. Methods We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR. Results 33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]). Conclusion 4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.

Download Full-text

Left circumflex scar burden quantified using cardiac magnetic resonance imaging (MRI) predicts severity of ischemic mitral regurgitation and postoperative mortality

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.07.398 ◽

2014 ◽

Vol 219 (4) ◽

pp. e4

Author(s):

Tatiana Chadid ◽

Kanika Kalra ◽

Robert Eisner ◽

Eric L. Sarin ◽

Robert A. Guyton ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Mitral Regurgitation ◽

Cardiac Magnetic Resonance Imaging ◽

Postoperative Mortality ◽

Ischemic Mitral Regurgitation ◽

Resonance Imaging ◽

Scar Burden ◽

Magnetic Resonance Imaging Mri

Download Full-text

Enhancing Magnetic Resonance Imaging With Computational Fluid Dynamics

Journal of Engineering and Science in Medical Diagnostics and Therapy ◽

10.1115/1.4045493 ◽

2019 ◽

Vol 2 (4) ◽

Author(s):

Giacomo Annio ◽

Ryo Torii ◽

Ben Ariff ◽

Declan P. O'Regan ◽

Vivek Muthurangu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Fluid Dynamics ◽

Computational Fluid Dynamics ◽

Blood Flow ◽

Magnetic Resonance ◽

Patient Specific ◽

Human Aorta ◽

Resonance Imaging ◽

4D Flow ◽

4D Flow Cmr

Abstract The analysis of the blood flow in the great thoracic arteries does provide valuable information about the cardiac function and can diagnose the potential development of vascular diseases. Flow-sensitive four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) is often used to characterize patients' blood flow in the clinical environment. Nevertheless, limited spatial and temporal resolution hinders a detailed assessment of the hemodynamics. Computational fluid dynamics (CFD) could expand this information and, integrated with experimental velocity field, enable to derive the pressure maps. However, the limited resolution of the 4D flow CMR and the simplifications of CFD modeling compromise the accuracy of the computed flow parameters. In this article, a novel approach is proposed, where 4D flow CMR and CFD velocity fields are integrated synergistically to obtain an enhanced MR imaging (EMRI). The approach was first tested on a two-dimensional (2D) portion of a pipe, to understand the behavior of the parameters of the model in this novel framework, and afterwards in vivo, to apply it to the analysis of blood flow in a patient-specific human aorta. The outcomes of EMRI are assessed by comparing the computed velocities with the experimental one. The results demonstrate that EMRI preserves flow structures while correcting for experimental noise. Therefore, it can provide better insights into the hemodynamics of cardiovascular problems, overcoming the limitations of MRI and CFD, even when considering a small region of interest. EMRI confirmed its potential to provide more accurate noninvasive estimation of major cardiovascular risk predictors (e.g., flow patterns, endothelial shear stress) and become a novel diagnostic tool.

Download Full-text

Comparison of mitral regurgitation severity assessments based on magnetic resonance imaging and echocardiography in patients with hypertrophic cardiomyopathy

Scientific Reports ◽

10.1038/s41598-021-99446-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mateusz Śpiewak ◽

Mariusz Kłopotowski ◽

Ewa Kowalik ◽

Łukasz Mazurkiewicz ◽

Katarzyna Kożuch ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Hypertrophic Cardiomyopathy ◽

Magnetic Resonance ◽

Mitral Regurgitation ◽

Cardiac Mri ◽

Treatment Options ◽

Resonance Imaging ◽

Regurgitant Volume ◽

Magnetic Resonance Imaging Mri ◽

Current Guidelines

AbstractMitral regurgitation (MR), which is one of the factors responsible for heart failure symptoms and the development of atrial fibrillation, is an important feature of hypertrophic cardiomyopathy (HCM), and its presence affects which treatment options are chosen. Although cardiac magnetic resonance imaging (MRI) is considered the reference standard for assessing the regurgitant volume (RV) and fraction (RF), echocardiography is the most common method for assessing MR severity. Accordingly, the aim of this study was to compare the results of echocardiography and cardiac MRI for assessing MR severity in a cohort of patients with HCM. MR severity was assessed in 53 patients using cardiac MRI by determining the mitral RV (MRV) and mitral RF (MRF). The results were graded according to thresholds recommended in current guidelines. MR severity assessed by echocardiography was graded by integrating indices of severity. Greater than mild MR, as assessed using echocardiography, was present in 22 patients (41.5%) with HCM and in none of the control patients (p = 0.001). In all, 31 patients (58.5%) had no more than mild MR. When MR severity was assessed using different methods, either moderate (kappa = 0.44, 95% confidence interval = 0.21–0.67), poor or no agreement was found between MRI-derived and echocardiography-derived grades. HCM patients with echocardiography-derived moderate and severe MR had similar median MRVs and MRFs (p = 0.59 and p = 0.11, respectively). In HCM patients, cardiac MRI and echocardiography were at most in modest agreement in assessing MR severity. Importantly, echocardiography-derived moderate and severe MR were not distinguishable by either MRV or MRF.

Download Full-text

Four-Dimensional Flow Magnetic Resonance Imaging and Applications in Cardiology

10.5772/intechopen.99362 ◽

2021 ◽

Author(s):

Patrick Geeraert ◽

Hansuk Kim ◽

Safia Ihsan Ali ◽

Ashifa Hudani ◽

Shirin Aliabadi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Blood Flow ◽

Magnetic Resonance ◽

Resonance Imaging ◽

4D Flow Mri ◽

4D Flow ◽

Great Vessels ◽

Flow Mri ◽

Magnetic Resonance Imaging Mri

Blood flow through the heart and great vessels moves in three dimensions (3D) throughout time. However, the assessment of its 3D nature has been limited in the human body. Recent advances in magnetic resonance imaging (MRI) allow for the comprehensive visualization and quantification of in-vivo flow dynamics using four-dimensional (4D) flow MRI. In addition, this technique provides the opportunity to obtain advanced hemodynamic biomarkers such as vorticity, helicity, wall shear stress (WSS), pressure gradients, viscous energy loss (EL), and turbulent kinetic energy (TKE). This chapter will introduce 4D flow MRI which is currently used for blood flow visualization and advanced quantification of cardiac hemodynamic biomarkers. We will discuss its advantages relative to other in-vivo flow imaging techniques and describe its potential clinical applications in cardiology.

Download Full-text

Abstract 20143: Direct in vivo Quantification of Intraplaque Hemorrhage and Fat in Atherosclerosis by Magnetic Resonance Imaging

Circulation ◽

10.1161/circ.130.suppl_2.20143 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sandeep Koppal ◽

Marcel Warntjes ◽

Jeremy Swann ◽

Petter Dyverfeldt ◽

Johan Kihlberg ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Flip Angle ◽

Mean Difference ◽

Intraplaque Hemorrhage ◽

Resonance Imaging ◽

4D Flow ◽

Flow Mri ◽

Magnetic Resonance Imaging Mri

Introduction: Intraplaque hemorrhage (IPH) and lipid core (LC) are hallmarks of rupture-prone atherosclerotic plaque. HYPOTHESIS: We hypothesized that IPH and LC can be quantified using R2* and fat measurements derived from four-point Dixon magnetic resonance imaging (MRI). Methods: Four patients scheduled for carotid endarterectomy underwent MRI in a 3T scanner applying: (a) T1weighted: TE=9ms, TR=1053ms (b) 4-point Dixon 3D gradient echo: TE=3.6ms, R=18ms, flip angle=10°, 2 REST slabs (c) 4-D flow MRI: TE=3.1ms, TR=5.4ms, flip angle=10°. IPH and fat were quantified from Dixon using custom software (Figure: visualization of IPH, red and LC, yellow as measured from Dixon MRI). After surgery, plaques were paraffin embedded and enface images were taken every 50μm. Every 200μm sections were taken for histology. A 3D histology volume was generated from this data and registered to MRI with the vessel lumen as a landmark. Area of IPH and LC upon histology was correlated to MRI values within these areas and MRI signal within IPH and LC was compared to MRI signal outside these areas. Results: Registration of 3D histology was through combining features from T1weighted MRI, first echo from Dixon and 4D flow MRI. Throughout all plaques the correlation between R2* and area of IPH as well as fat from Dixon and area of LC upon histology was high (IPH: Pearson r 0.451, 95% CI: 0.364 t- 0.530, P<0.0001; LC: Pearson r 0.148, 95% CI: 0.0635 - 0.231, P<0.001). Throughout each plaque R2* within IPH was significantly higher than outside (mean difference±SEM/patient: (i) 11.96 ± 2.091 (ii) 7.616 ± 2.154 (iii) 12.66 ± 1.412 (iv) 14.13 ± 2.144; P<0.001). Fat from Dixon was significantly higher inside LC than outside (mean difference±SEM/patient: (i) 1.796 ± 0.386 (ii) 3.078 ± 0.328 (iii) 6.610 ± 0.651 (iv) 0.481 ± 0.242 N=167; P<0.0001). Conclusions: R2* and fat measured from Dixon MRI reliably quantifies the extent of IPH and LC in atherosclerotic plaques as validated by 3D histology.

Download Full-text