Jiwei Sun¹, Hong Zhang¹, Anhong Yu¹, Jianxiu Lian², Yufan Gao¹, Wei Yuan¹, and Yapeng Yang^1
1Radiology, Tianjin Chest Hospital, Tianjin, China, ²Philips Healthcare, Beijing, China

Keywords: Flow, Blood, hemodynamic

Few studies quantitatively evaluate pulmonary artery hemodynamic changes caused by emphysema. 34 COPD patients were divided into two groups according to emphysema volume and 12 healthy volunteers were matched. Hemodynamic parameters were calculated by 4D-Flow MRI and right ventricular function indicators were evaluated for three groups. The right systolic pressure drop and RVEF were lower in moderate and severe emphysema group but the right EL was higher. The whole-lung emphysema score correlated negatively with RVEF and the right systolic pressure drop. 4D-Flow combined with cine image can comprehensively evaluate the pulmonary artery hemodynamics and right ventricular function of COPD patients.

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Denise Lichthardt¹, Jens Wetzl², Michaela Schmidt², Peter Speier², Armin M. Nagel¹, and Daniel Giese^2
1Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany, ²Siemens Healthcare GmbH, Erlangen, Germany

Keywords: Flow, Cardiovascular

Phase contrast MRI enables flow measurement in the coronary arteries. Herewith we propose a 3D Flow sequence and present a novel 3D visualization and quantification tool. Whole heart 3D PC measurements were performed in more than 20 healthy volunteers. An isotropic resolution of 1.2x1.2x1.2mm³ was used, as well as an undersampling factor of 14 in combination with a compressed sensing reconstruction. Our postprocessing tool was used for the 3D visualization of blood flow information as well as quantification of flow velocities per slice perpendicular to the vessel centerline.

 

 

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Aparna Sodhi¹, Ethan Johnson², Elizabeth Weiss², Haben Berhane², Dr. Joshua Robinson³, Dr. Andrada Popescu¹, Dr. Michael Markl², and Dr. Cynthia Rigsby^1
1Department of Medical Imaging, Ann & Robert H Lurie Children's Hospital, Chicago, IL, United States, ²Department of Radiology, Northwestern University, Chicago, IL, United States, ³Department of Cardiology, Ann & Robert H Lurie Children's Hospital, Chicago, IL, United States

Keywords: Flow, Cardiovascular, Marfan Syndrome, Loeys-Dietz Syndrome, Vascular Ehlers-Danlos syndrome

Quantitative overview of 4D flow derived aortic hemodynamic parameters such as kinetic energy, peak velocity, and pulse wave velocity in a cohort of pediatric patients with connective tissue disorders such as Marfan Syndrome (MFS), Loeys-Dietz Syndrome (LDS), and Vascular Ehlers-Danlos Syndrome (EDS), using a fully automated pipeline. A statistically significant trend of increased pulse wave velocity - an important measure of vessel stiffness, with increasing age was observed for this cohort. No association was found between PWV and all mean aortic diameters when controlled for age.

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Chiara Trenti^1,2, Filip Hammaréus¹, Tino Ebbers^1,2, Eva Swahn^1,3, Lena Jonasson¹, and Petter Dyverfeldt^1,2
1Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden, ²Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden, ³Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

Keywords: Flow, Vessels, Aorta

Altered hemodynamics may play a role in the development of ascending aortic aneurysms. In this study, we sought to investigate wall shear stress and flow displacement in patients with tricuspid aortic valve and mild-to-moderate dilatation of the ascending aorta, and age-and sex- matched non-dilated controls. Dilated patients had lower average velocity and wall shear stress in the ascending aorta, and higher flow displacement. This study shows that individuals with dilatation have altered hemodynamics even in an early stage of the disease.

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Eva Aalbregt^1,2, Aart J. Nederveen², Kak Khee Yeung¹, R. Nils Planken², Ron Balm ¹, and Pim van Ooij^2
1Vascular Surgery, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands, ²Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands

Keywords: Flow, Quantitative Imaging, abdominal aortic aneurysm

The aim of this study was to assess the reproducibility and inter- and intra-observer agreement for estimating wall shear stress (WSS) in abdominal aortic aneurysms (AAAs) based on 4D flow magnetic resonance imaging (MRI). Asymptomatic AAA patients were included and scanned twice with a one-week interval. Phase-contrast angiographies were acquired by voxel-wise multiplication of magnitude and phase data. Based on statistical analyses the reproducibility was good. An inverse correlation was found between WSS and lumen diameter. Both vorticity and intraluminal thrombus volume were associated with minimum WSS in AAA. 4D flow MRI is robust for estimating WSS in AAAs. 

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Ryota Hyodo¹, Yasuo Takehara^1,2, Takashi Mizuno³, Kazushige Ichikawa⁴, Yoji Ishizu⁵, Yasuhiro Ogura⁶, and Shinji Naganawa^7
1Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan, ²Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Japan, ³Radiological Technology, Nagoya Uviversity Hospital, Nagoya, Japan, ⁴RadiologicalTechnology, Nagoya Uviversity Hospital, Nagoya, Japan, ⁵Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan, ⁶Transplantation Surgery, Nagoya Uviversity Hospital, Nagoya, Japan, ⁷Nagoya University Graduate School of Medicine, Nagoya, Japan

Keywords: Flow, Velocity & Flow

Although liver cirrhosis is an independent risk factor for portal vein thrombosis (PVT), the individual thrombotic risk assessment is complex. Recently, 4D flow MRI has begun to assess portal blood flow; however, there have been no reports of the use of RRT, an indicator of blood flow stagnation, in the portal system. RRT may be used to measure the risk of PVT in liver cirrhosis. In this study, we evaluated the mean RRT value of the main PV calculated with 4D flow MRI and found that the value was significantly higher in cirrhotic patients than in non-cirrhotic subjects.

Xiaohuan Li¹, Zhou Wei¹, Zhiyuan Chen¹, Dongjing Zhou¹, Shuping Zhang¹, Ruhang Huang¹, Yunzhu Wu², and Yupin Liu*^1
1Department of radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China, ²MR Scientific Marketing, Siemens Healthineers Ltd, Shanghai, China

Keywords: Flow, Velocity & Flow

Noninvasive identification of high-risk varices (HRV) in cirrhosis patients is of significantly value because it could help avoid some unnecessary upper gastrointestinal endoscopy and repeat in a short time to evaluate the efficiency of non-selective beta blockers therapy. This study aims to evaluate the value of 4D flow MRI combined with precontrast T1 in identifying HRV. Our results indicated that the model including SMV forward volume, SMV maximum blood flow, precontrast liver T1 mapping, and precontrast spleen T1 mapping could effectively identify HRV of cirrhosis patients.

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Tetusro Sekine¹ and Shinichiro Kumita^1
1Nippon Medical School, Tokyo, Japan

Keywords: Flow, Cardiovascular

 The purpose was to validate whether turbulent kinetic energy (TKE) and viscous energy loss (VEL) reflect the condition of hypertrophic cardiomyopathy (HCM). We included consecutive 32 HCM patients. They were classified into HOCM (HCM with left ventricular outflow tract obstruction [LVOTO]) (n=21) and HNCM (HCM without LVOTO) (n=11) based on cardiac ultrasound. Both TKE and VEL were significantly higher in HOCM than HNCM. The strong correlation was observed between normalized LVmass and normalized TKEpeak in asymptomatic HCM (nTKEpeak r=0.879, p<0.001), but not in symptomatic HCM. The TKEpeak had the strongest correlation to each disease condition than the others.

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Chiara Trenti^1,2, Petter Dyverfeldt^1,2, Paul W.M. Fedak³, James A. White³, and Julio Garcia^3,4,5,6
1Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden, ²Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden, ³Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, ⁴Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada, ⁵Department of Radiology, University of Calgary, Calgary, AB, Canada, ⁶Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada

Keywords: Flow, Vessels, Aorta

Individuals with bicuspid aortic valve (BAVs) and aortic regurgitation have higher rate of aortic complications compared to individuals with stenotic and functioning BAVs. We sought to investigate wall shear stress (WSS) and oscillatory shear index (OSI) in the ascending aorta of BAVs with functioning valves, stenotic and regurgitant valves, as well as controls with tricuspid aortic valves. BAVs with regurgitation had similar WSS compared to all other groups, but OSI was almost twice as high. This finding may be related to the pendulum volume between the aorta and the left ventricle. Studying OSI may improve the understanding behind BAV aortopathy.

Yun Zhao¹, Lu Huang¹, Xiaoyue Zhou², and Liming Xia^1
1Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, ²MR Collaboration, Siemens Healthineers Ltd, Shanghai, China

Keywords: Flow, Blood, 4D flow MRI; Hemodynamics; Energy loss; Hypertrophic Obstructive Cardiomyopathy;

Hypertrophic Obstructive Cardiomyopathy (HOCM) is characterized by dynamic obstruction of blood flow in the left ventricular outflow tract. 4D flow MRI can be used for comprehensive evaluation of cardiac and aortic hemodynamics by visualization of the complex spiral LVOT 3D blood flow patterns. This study used 4D flow MRI to evaluate the degree of LVOT obstruction and the flow energy loss in patients with HOCM. The results showed that spiral flow and viscous energy loss were associated with the LVOT pressure gradient, and played a role in structural remodeling of the left ventricle.

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Yuting Wang¹, Haining Wei², Meixiong Cheng³, Yishuang Wang¹, Yunzhu Wu⁴, Mingzhu Fu², and Rui Li^2
1Radiology, Sichuan Provincial People's Hospital, Chengdu, China, ²Center for Biomedical Imaging Research Beijing, Qinghua University, Beijing, China, ³Neurosurgery, Sichuan Provincial People's Hospital, Chengdu, China, ⁴Siemens Healthineers Ltd., Shanghai, China

Keywords: Flow, Velocity & Flow, arteriovenous malformation

The hemodynamics of cerebral AVM likely vary with lesion angioarchitecture and the rupture status, which couldn’t be reflected by morphology-based imaging. In this pilot study, 9 patients with AVM had their complicated feeding/draining patterns visualized by 4D-flow MR. AVM tend to have heterogeneous hemodynamics even with the same Spetzler-Martin grade or similar angioarchitecture. It tends to have smaller flow of the feeding artery after rupture. AVM with deep vein drainage tends to have diffused nidus and higher wall shear stress adjacent to the nidus. Higher flow of the feeding artery was associated with higher dynamic pressure and larger nidus volume.

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Yuxin Liu¹, Haining Wei¹, Tian Bing², Hou Yuxi², Mingzhu Fu¹, and Rui Li^1
1Center for Biomedical Imaging Research, Tsinghua University, Beijing, China, ²Changhai Hospital, Shanghai, China

Keywords: Flow, Velocity & Flow, Hemodynamics

Intracranial aneurysm has become an important issue because of the high morbidity and the high mortality rate due to aneurysm rupture. Recently, the flow diverter stent has been considered as an effective device for the treatment of aneurysms by modifying the hemodynamics of the aneurysm. 4D Flow MRI can can offer three-dimensional visualization of blood flow pattern and a comprehensive analysis of hemodynamics. In this study, we calculated and analyzed the hemodynamics in aneurysm hemodynamics before and after the implantation of flow diverter stents based on 4D Flow MRI.

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Wen Zeng¹, Chunchao Xia¹, Xiaoyong Zhang², and Zhenlin Li^1
1West China Hospital, Sichuan University, Chengdu, China, ²Clinical Science, Philips Healthcare, Chengdu, China, Chengdu, China

Keywords: Flow, Cardiovascular, Abdominal aortic aneurysm

Studies have confirmed the interaction between iliac arteries and abdominal aortic aneurysms. Four-dimensional (4D) flow MRI can reveal the hemodynamic changes of common iliac arteries in abdominal aortic aneurysm and health controls. In this study, we tried to explain the relationship between the changes of iliac artery hemodynamics and the asymmetry of the left and right iliac artery blood flow and the occurrence and development of abdominal aortic aneurysms in patients.

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Simon Thalén¹, Peder Sörensson², Daniel Giese³, Andreas Sigfridsson¹, and Martin Ugander^1,4
1Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, ²Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, ³Siemens Healthineers, Erlangen, Germany, ⁴Kolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, Sydney, Australia

Keywords: Flow, Velocity & Flow, Ventricular interdependence

Diastolic ventricular interdependence occurs in several clinical settings, most notably pericardial effusion and constrictive pericarditis. It is measured using Doppler echocardiography or invasive cardiac catheterization where the respiratory variation in velocity or pressure is measured. In pericardial effusion it is an early sign of hemodynamic significance which is not always correlated to the volume of effusion. In constrictive pericarditis, it is used to separate constrictive and restrictive physiologies. In this study a method to measure diastolic ventricular interdependence by simultaneously quantifying the respiratory variation in mitral and tricuspid early inflow velocities using real time phase contrast CMR is presented.

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Josh Engel¹, Ozden Kilinc¹, Justin Baraboo², Elizabeth Weiss^1,2, Christopher Mehta³, Andrew Hoel⁴, S. Chris Malaisrie³, Michael Markl², and Bradley Allen^1
1Radiology, Northwestern University, Chicago, IL, United States, ²Biomedical Engineering, Northwestern University, Chicago, IL, United States, ³Cardiac Surgery, Northwestern Medicine, Chicago, IL, United States, ⁴Vascular Surgery, Northwestern Medicine, Chicago, IL, United States

Keywords: Vessels, Velocity & Flow, Aortic Dissection, 4D Flow

We investigated whether changes in 4D flow-derived hemodynamic parameters stratified type B aortic dissection patients and sought to validate a 4D flow-derived 2D planar false lumen flow method. Patient scans with baseline and follow-up 4D flow at least 120 days apart were manually segmented into true and false lumens. Voxel-wise parametric maps and 2D forward and reverse flow in the descending aorta were calculated. Changes in voxel-wise hemodynamic parameters significantly correlated with aortic growth rate, with changes in false lumen reverse flow as the most robust parameter. 2D planar flow correlated with voxel-wise flow, but not aortic growth. 

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Yuying Chen¹, Yang Peng¹, Yu Feng¹, Jun Yuan¹, Lin Peng¹, Mengzhu Wang², and Ning Jin^3
1The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, ²MR Scientific Marketing, Siemens Healthineers Ltd., Guangzhou, China, ³Siemens Medical Solutions USA, Inc. Customer Solutions Group，Siemens Healthineers, MR Scientific Marketing, Siemens Healthineers Ltd., Chicago, IL, United States

Keywords: Cardiomyopathy, Cardiomyopathy, 4D flow

This study aimed to investigate the potential of ventricular flow parameters derived from four‑dimensional (4D) flow cardiovascular magnetic resonance (CMR) to accurately support assessment of hypertrophic cardiomyopathy (HCM). Our results show that reduced left ventricular (LV) residual volume was associated with LV dysfunction. Higher LV retained inflow and lower delayed ejection inflow were observed in obstructive HCM patients. Flow components and kinetic energy correlated significantly with LV functional and remodelling CMR parameters. These findings suggest that 4D flow CMR may be potential method to explain the relationship between hemodynamic and pathophysiological changes in HCM.

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Jeesoo Lee¹, Adarsh Aratikatla¹, Erik Wu², Taimur Safder³, Gloria Ayuba³, James Thomas³, and Michael Markl^4
1Radiology, Northwestern University, Chicago, IL, United States, ²Northwestern University, Chicago, IL, United States, ³Cardiology, Northwestern Memorial Hospital, Chicago, IL, United States, ⁴Radiology, Northwestern University, chicago, IL, United States

Keywords: Valves, Velocity & Flow, Mitral valvular regurgitation, 4D flow MRI, Jet momentum

Quantitative hemodynamic assessment of mitral valvular regurgitation (MVR) is critical for evaluating severity of the disease, but has been challenging with conventional echocardiographic and cardiac MRI techniques. 4D flow MRI is a promising tool that enables direct retrospective quantification of MVR hemodynamics. This study proposes a regurgitant flow momentum as a novel and reliable fluid dynamic parameter for MVR assessment using 4D flow MRI. The conservation characteristics of MVR jet flow momentum and its relationship with LA enlargement were investigated in 44 patients using 4D flow MRI and echocardiography. 

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Jingyu Zhang¹, Di Tian¹, Ziqi Xiong¹, Yifan He¹, and Zhiyong Li^1
1The First Affiliated Hospital of Dalian Medical University, Dalian, China

Keywords: Heart, Heart

Four-dimensional flow cardiovascular magnetic resonance imaging (4d-flow CMR) left ventricular kinetic energy (LVKE) parameter Peak A- wave KEiEDV increased, KEiEDV E/A ratio decreased with age. This suggests that 4d-flow CMR LVKE parameters can respond to age-induced changes in LV diastolic function.

Elodie Piot¹, Nicolas Duchateau¹, Marine Menut², Benyebka Bou-Said², Patrick Clarysse¹, Philippe Douek^1,3, Karl Kunze⁴, Rene Botnar⁵, Sara Boccalini⁶, Claudia Prieto⁵, and Monica Sigovan^1
1CREATIS, Lyon, France, ²INSA de Lyon, Lyon, France, ³Departement of Radiology, HCL, Lyon, France, ⁴Siemens Helthineers, London, United Kingdom, ⁵School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom, ⁶Department of Radiology, HCL, Lyon, France

Keywords: Data Processing, Blood vessels

Understanding the hemodynamic involvement in a vascular pathology requires inter-subject comparisons that are not straightforward due to variability in terms of aorta morphology. Hemodynamic atlases can facilitate detection of intra-group characteristics. We propose here a workflow to create a hemodynamic atlas using 4D Flow MRI. In addition, we propose to investigate the aorta wall stiffness using non-rigid image registration and inverse mechanical modeling. This type of analysis is expected to improve pathophysiological understanding of vascular disease, by enabling the investigation of potential correlations between hemodynamic and wall mechanical properties at each point of the aorta.