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Zvolanek KM, Moore JE, Jarvis K, Moum SJ, Bright MG. Macrovascular blood flow and microvascular cerebrovascular reactivity are regionally coupled in adolescence. J Cereb Blood Flow Metab 2025; 45:746-764. [PMID: 39534950 PMCID: PMC11563552 DOI: 10.1177/0271678x241298588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 09/09/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024]
Abstract
Cerebrovascular imaging assessments are particularly challenging in adolescent cohorts, where not all modalities are appropriate, and rapid brain maturation alters hemodynamics at both macro- and microvascular scales. In a preliminary sample of healthy adolescents (n = 12, 8-25 years), we investigated relationships between 4D flow MRI-derived blood velocity and blood flow in bilateral anterior, middle, and posterior cerebral arteries and BOLD cerebrovascular reactivity (CVR) in associated vascular territories. As hypothesized, higher velocities in large arteries are associated with an earlier response to a vasodilatory stimulus (cerebrovascular reactivity delay) in the downstream territory. Higher blood flow through these arteries is associated with a larger BOLD response to a vasodilatory stimulus (cerebrovascular reactivity amplitude) in the associated territory. These trends are consistent in a case study of adult moyamoya disease. In our small adolescent cohort, macrovascular-microvascular relationships for velocity/delay and flow/CVR change with age, though underlying mechanisms are unclear. Our work emphasizes the need to better characterize this key stage of human brain development, when cerebrovascular hemodynamics are changing, and standard imaging methods offer limited insight into these processes. We provide important normative data for future comparisons in pathology, where combining macro- and microvascular assessments may better help us prevent, stratify, and treat cerebrovascular disease.
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Affiliation(s)
- Kristina M Zvolanek
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
| | - Jackson E Moore
- Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
- Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly Jarvis
- Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah J Moum
- Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Molly G Bright
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
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Bochert D, Hofer S, Dechent P, Frahm J, Bähr M, Liman J, Maier I. Blood Flow Velocities as Determined by Real-Time Phase-Contrast MRI in Patients With Carotid Artery Stenosis. J Neuroimaging 2025; 35:e70016. [PMID: 39994822 PMCID: PMC11850646 DOI: 10.1111/jon.70016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/08/2025] [Accepted: 01/09/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND AND PURPOSE Real-time phase-contrast (RT-PC) flow MRI can be used to determine quantitative flow parameters throughout the vessel lumen of extracranial, brain-supplying arteries. Its potential value in the diagnostic workup of patients with carotid artery stenosis has not been evaluated. METHODS RT-PC flow MRI was performed in 10 patients with carotid stenosis in comparison to conventional neurovascular ultrasound (nvUS). Peak systolic velocity, end-diastolic velocity, mean flow velocity, and flow volumes have been evaluated by RT-PC flow MRI. Measurements have been performed at standardized sites along the common, internal, and external carotid arteries on both sides and at the maximum of the carotid stenosis. RESULTS Blood flow velocities were significantly lower with RT-PC flow MRI compared to nvUS and not consistently correlated between both methods. Within the maximum of the carotid stenosis, RT-PC flow MRI showed implausible flow velocity reductions compared to nvUS. In contrast, the flow volumes determined by RT-PC flow MRI-with exception of the stenosis maximum-were comparable with nvUS and significantly correlated in the prestenotic common carotid artery. CONCLUSION RT-PC flow MRI does not appear to be suitable for quantifying blood flow velocities and volumes in the patients with carotid stenosis compared to nvUS. Apart from the lower temporal resolution of RT-PC MRI, the lack of correlation of blood flow velocities might be ascribed to the prevalence of nonlaminar flow within and behind the stenosis, which violates a general prerequisite for valid flow velocity measurements by PC MRI.
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Affiliation(s)
- Deborah Bochert
- Department of NeurologyUniversity Medical Center GöttingenGottingenNiedersachsenGermany
| | - Sabine Hofer
- Department of NeurologyUniversity Medical Center GöttingenGottingenNiedersachsenGermany
| | - Peter Dechent
- Department of Cognitive NeurologyUniversity Medical Center GöttingenGottingenNiedersachsenGermany
| | - Jens Frahm
- Biomedical NMRMax Planck Institute for Multidisciplinary SciencesGottingenNiedersachsenGermany
| | - Mathias Bähr
- Department of NeurologyUniversity Medical Center GöttingenGottingenNiedersachsenGermany
| | - Jan Liman
- Department of NeurologyParacelsus Medical SchoolNurembergBayernGermany
| | - Ilko Maier
- Department of NeurologyUniversity Medical Center GöttingenGottingenNiedersachsenGermany
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Muccio M, Sun Z, Chu D, Damadian BE, Minkoff L, Bonanni L, Ge Y. The impact of body position on neurofluid dynamics: present insights and advancements in imaging. Front Aging Neurosci 2024; 16:1454282. [PMID: 39582951 PMCID: PMC11582045 DOI: 10.3389/fnagi.2024.1454282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 10/29/2024] [Indexed: 11/26/2024] Open
Abstract
The intricate neurofluid dynamics and balance is essential in preserving the structural and functional integrity of the brain. Key among these forces are: hemodynamics, such as heartbeat-driven arterial and venous blood flow, and hydrodynamics, such as cerebrospinal fluid (CSF) circulation. The delicate interplay between these dynamics is crucial for maintaining optimal homeostasis within the brain. Currently, the widely accepted framework for understanding brain functions is the Monro-Kellie's doctrine, which posits a constant sum of intracranial CSF, blood flow and brain tissue volumes. However, in recent decades, there has been a growing interest in exploring the dynamic interplay between these elements and the impact of external factors, such as daily changes in body position. CSF circulation in particular plays a crucial role in the context of neurodegeneration and dementia, since its dysfunction has been associated with impaired clearance mechanisms and accumulation of toxic substances. Despite the implementation of various invasive and non-invasive imaging techniques to investigate the intracranial hemodynamic or hydrodynamic properties, a comprehensive understanding of how all these elements interact and are influenced by body position remains wanted. Establishing a comprehensive overview of this topic is therefore crucial and could pave the way for alternative care approaches. In this review, we aim to summarize the existing understanding of intracranial hemodynamic and hydrodynamic properties, fundamental for brain homeostasis, along with factors known to influence their equilibrium. Special attention will be devoted to elucidating the effects of body position shifts, given their significance and remaining ambiguities. Furthermore, we will explore recent advancements in imaging techniques utilized for real time and non-invasive measurements of dynamic body fluid properties in-vivo.
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Affiliation(s)
- Marco Muccio
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Zhe Sun
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
| | - David Chu
- FONAR Corporation, Melville, NY, United States
| | - Brianna E. Damadian
- Department of Radiology, Northwell Health-Lenox Hill Hospital, New York, NY, United States
| | | | | | - Yulin Ge
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
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Zvolanek KM, Moore JE, Jarvis K, Moum SJ, Bright MG. Macrovascular blood flow and microvascular cerebrovascular reactivity are regionally coupled in adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.26.590312. [PMID: 38746187 PMCID: PMC11092525 DOI: 10.1101/2024.04.26.590312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Cerebrovascular imaging assessments are particularly challenging in adolescent cohorts, where not all modalities are appropriate, and rapid brain maturation alters hemodynamics at both macro- and microvascular scales. In a preliminary sample of healthy adolescents (n=12, 8-25 years), we investigated relationships between 4D flow MRI-derived blood velocity and blood flow in bilateral anterior, middle, and posterior cerebral arteries and BOLD cerebrovascular reactivity in associated vascular territories. As hypothesized, higher velocities in large arteries are associated with an earlier response to a vasodilatory stimulus (cerebrovascular reactivity delay) in the downstream territory. Higher blood flow through these arteries is associated with a larger BOLD response to a vasodilatory stimulus (cerebrovascular reactivity amplitude) in the associated territory. These trends are consistent in a case study of adult moyamoya disease. In our small adolescent cohort, macrovascular-microvascular relationships for velocity/delay and flow/CVR change with age, though underlying mechanisms are unclear. Our work emphasizes the need to better characterize this key stage of human brain development, when cerebrovascular hemodynamics are changing, and standard imaging methods offer limited insight into these processes. We provide important normative data for future comparisons in pathology, where combining macro- and microvascular assessments may better help us prevent, stratify, and treat cerebrovascular disease.
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Affiliation(s)
- Kristina M. Zvolanek
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
| | - Jackson E. Moore
- Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
- Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly Jarvis
- Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah J. Moum
- Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Molly G. Bright
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, USA
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Xie L, Zhang Y, Hong H, Xu S, Cui L, Wang S, Li J, Liu L, Lin M, Luo X, Li K, Zeng Q, Zhang M, Zhang R, Huang P. Higher intracranial arterial pulsatility is associated with presumed imaging markers of the glymphatic system: An explorative study. Neuroimage 2024; 288:120524. [PMID: 38278428 DOI: 10.1016/j.neuroimage.2024.120524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Arterial pulsation has been suggested as a key driver of paravascular cerebrospinal fluid flow, which is the foundation of glymphatic clearance. However, whether intracranial arterial pulsatility is associated with glymphatic markers in humans has not yet been studied. METHODS Seventy-three community participants were enrolled in the study. 4D phase-contrast magnetic resonance imaging (MRI) was used to quantify the hemodynamic parameters including flow pulsatility index (PIflow) and area pulsatility index (PIarea) from 13 major intracerebral arterial segments. Three presumed neuroimaging markers of the glymphatic system were measured: including dilation of perivascular space (PVS), diffusivity along the perivascular space (ALPS), and volume fraction of free water (FW) in white matter. We explored the relationships between PIarea, PIflow, and the presumed glymphatic markers, controlling for related covariates. RESULTS PIflow in the internal carotid artery (ICA) C2 segment (OR, 1.05; 95 % CI, 1.01-1.10, per 0.01 increase in PI) and C4 segment (OR, 1.05; 95 % CI, 1.01-1.09) was positively associated with the dilation of basal ganglia PVS, and PIflow in the ICA C4 segment (OR, 1.06, 95 % CI, 1.02-1.10) was correlated with the dilation of PVS in the white matter. ALPS was associated with PIflow in the basilar artery (β, -0.273, p, 0.046) and PIarea in the ICA C2 (β, -0.239, p, 0.041) and C7 segments (β, -0.238, p, 0.037). CONCLUSIONS Intracranial arterial pulsatility was associated with presumed neuroimaging markers of the glymphatic system, but the results were not consistent across different markers. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Linyun Xie
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Yao Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Hui Hong
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Shan Xu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Lei Cui
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Shuyue Wang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Jixuan Li
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Lingyun Liu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Miao Lin
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Xiao Luo
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Kaicheng Li
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Qingze Zeng
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Ruiting Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China
| | - Peiyu Huang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China.
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Caddy HT, Thomas HJ, Kelsey LJ, Smith KJ, Doyle BJ, Green DJ. Comparison of computational fluid dynamics with transcranial Doppler ultrasound in response to physiological stimuli. Biomech Model Mechanobiol 2024; 23:255-269. [PMID: 37805938 PMCID: PMC10902019 DOI: 10.1007/s10237-023-01772-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023]
Abstract
Cerebrovascular haemodynamics are sensitive to multiple physiological stimuli that require synergistic response to maintain adequate perfusion. Understanding haemodynamic changes within cerebral arteries is important to inform how the brain regulates perfusion; however, methods for direct measurement of cerebral haemodynamics in these environments are challenging. The aim of this study was to assess velocity waveform metrics obtained using transcranial Doppler (TCD) with flow-conserving subject-specific three-dimensional (3D) simulations using computational fluid dynamics (CFD). Twelve healthy participants underwent head and neck imaging with 3 T magnetic resonance angiography. Velocity waveforms in the middle cerebral artery were measured with TCD ultrasound, while diameter and velocity were measured using duplex ultrasound in the internal carotid and vertebral arteries to calculate incoming cerebral flow at rest, during hypercapnia and exercise. CFD simulations were developed for each condition, with velocity waveform metrics extracted in the same insonation region as TCD. Exposure to stimuli induced significant changes in cardiorespiratory measures across all participants. Measured absolute TCD velocities were significantly higher than those calculated from CFD (P range < 0.001-0.004), and these data were not correlated across conditions (r range 0.030-0.377, P range 0.227-0.925). However, relative changes in systolic and time-averaged velocity from resting levels exhibited significant positive correlations when the distinct techniques were compared (r range 0.577-0.770, P range 0.003-0.049). Our data indicate that while absolute measures of cerebral velocity differ between TCD and 3D CFD simulation, physiological changes from resting levels in systolic and time-averaged velocity are significantly correlated between techniques.
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Affiliation(s)
- Harrison T Caddy
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Australia
| | - Hannah J Thomas
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Australia
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia
- School of Engineering, The University of Western Australia, Perth, Australia
| | - Kurt J Smith
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Australia
- Cerebrovascular Health, Exercise, and Environmental Research Sciences Laboratory, University of Victoria, Victoria, Canada
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia.
- School of Engineering, The University of Western Australia, Perth, Australia.
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Australia
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Hsieh YL, Wang W. Case report: Novel transtemporal transverse sinus decompression surgery to alleviate transverse sinus stenosis in a pulsatile tinnitus patient with restricted bilateral venous outflow. Front Surg 2023; 10:1268829. [PMID: 37841818 PMCID: PMC10573303 DOI: 10.3389/fsurg.2023.1268829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Transverse sinus (TS) stenosis is common in individuals with venous pulsatile tinnitus (PT). While PT can be addressed by endoluminal or extraluminal methods, the former has shown promise in alleviating symptoms associated with increased intracranial pressure. This study explores the potential of extraluminal methods to alleviate TS stenosis and eliminate PT caused by sigmoid sinus diverticulum. A 31-year-old male patient presenting with left-sided PT, attributed to a large, pedunculated sigmoid sinus diverticulum along with severe ipsilateral TS stenosis and contralateral TS hypoplasia, underwent ipsilateral extraluminal TS decompression surgery following sigmoid sinus wall reconstruction under local anesthesia. Postoperative CT and MR angiography revealed a significant increase in the TS lumen from 0.269 to 0.42 cm2 (56.02%) 2 years after surgery. Cervical Doppler ultrasound demonstrated a 36.07% increase in ipsilateral outflow volume to 16.6 g/s and a 77.63% increase in contralateral outflow volume to 1.35 g/s. In conclusion, this pioneering study showcases the potential of transtemporal TS decompression surgery in creating space for adaptive expansion of the TS lumen. However, the procedure should be reserved for individuals with severely compromised venous return.
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Affiliation(s)
| | - Wuqing Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Fico BG, Miller KB, Rivera-Rivera LA, Corkery AT, Pearson AG, Loggie NA, Howery AJ, Rowley HA, Johnson KM, Johnson SC, Wieben O, Barnes JN. Cerebral hemodynamics comparison using transcranial doppler ultrasound and 4D flow MRI. Front Physiol 2023; 14:1198615. [PMID: 37304825 PMCID: PMC10250020 DOI: 10.3389/fphys.2023.1198615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction: Age-related changes in cerebral hemodynamics are controversial and discrepancies may be due to experimental techniques. As such, the purpose of this study was to compare cerebral hemodynamics measurements of the middle cerebral artery (MCA) between transcranial Doppler ultrasound (TCD) and four-dimensional flow MRI (4D flow MRI). Methods: Twenty young (25 ± 3 years) and 19 older (62 ± 6 years) participants underwent two randomized study visits to evaluate hemodynamics at baseline (normocapnia) and in response to stepped hypercapnia (4% CO2, and 6% CO2) using TCD and 4D flow MRI. Cerebral hemodynamic measures included MCA velocity, MCA flow, cerebral pulsatility index (PI) and cerebrovascular reactivity to hypercapnia. MCA flow was only assessed using 4D flow MRI. Results: MCA velocity between the TCD and 4D flow MRI methods was positively correlated across the normocapnia and hypercapnia conditions (r = 0.262; p = 0.004). Additionally, cerebral PI was significantly correlated between TCD and 4D flow MRI across the conditions (r = 0.236; p = 0.010). However, there was no significant association between MCA velocity using TCD and MCA flow using 4D flow MRI across the conditions (r = 0.079; p = 0.397). When age-associated differences in cerebrovascular reactivity using conductance were compared using both methodologies, cerebrovascular reactivity was greater in young adults compared to older adults when using 4D flow MRI (2.11 ± 1.68 mL/min/mmHg/mmHg vs. 0.78 ± 1.68 mL/min/mmHg/mmHg; p = 0.019), but not with TCD (0.88 ± 1.01 cm/s/mmHg/mmHg vs. 0.68 ± 0.94 cm/s/mmHg/mmHg; p = 0.513). Conclusion: Our results demonstrated good agreement between the methods at measuring MCA velocity during normocapnia and in response to hypercapnia, but MCA velocity and MCA flow were not related. In addition, measurements using 4D flow MRI revealed effects of aging on cerebral hemodynamics that were not apparent using TCD.
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Affiliation(s)
- Brandon G. Fico
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Kathleen B. Miller
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Leonardo A. Rivera-Rivera
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam T. Corkery
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew G. Pearson
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole A. Loggie
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna J. Howery
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
| | - Howard A. Rowley
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kevin M. Johnson
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veteran’s Hospital, Madison, WI, United States
| | - Oliver Wieben
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jill N. Barnes
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, United States
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van den Kerkhof M, Jansen JFA, van Oostenbrugge RJ, Backes WH. 1D versus 3D blood flow velocity and pulsatility measurements of lenticulostriate arteries at 7T MRI. Magn Reson Imaging 2023; 96:144-150. [PMID: 36473545 DOI: 10.1016/j.mri.2022.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE 7T MRI enables measurements of blood flow velocity waveforms in small, perforating cerebral arteries. As these vessels can be tortuous, acquisition methods sensitive to flow in only one direction may not be sufficient to accurately determine the dynamic blood flow velocity. In this study, we compared 1D with 3D velocity encoding to measure the blood flow velocity and pulsatility in the lenticulostriate arteries (LSAs). METHODS Blood flow velocity waveforms were measured in the LSAs of 18 subjects (age range: 20-74 years) using prospectively gated single-slice phase contrast (PC) MRI at 7T. For each subject, blood flow velocity waveforms were acquired in a single slice with one velocity encoding as well as three orthogonal velocity encodings. The peak velocity and pulsatility index (PI) were determined in the largest, perpendicularly planned LSA, one obliquely planned LSA and three smaller LSAs. The peak velocity and PI were compared between 1D and 3D measurements using Bland-Altman analysis, with the 95% limits of agreement (LOA) taken into account. RESULTS For the largest, perpendicularly planned LSA, the peak velocity was slightly lower (0.2 cm/s, 1.7%) for 1D compared to 3D measurements, with an LOA range from the mean difference of (-0.27;0.27). The PI was slightly higher (0.01, 1.6%) for the 1D measurement, and an LOA range from the mean difference in PI of (-0.045;0.045). The obliquely planned LSA and three smaller LSAs demonstrated larger deviations (range mean percentage difference: 3.9-8.2%). CONCLUSION 1D velocity encoding using 2D PC MRI provides sufficiently accurate dynamic velocity and pulsatility measurements in slices perpendicularly planned to single, large LSAs compared to 3D velocity encoding, while increasing errors are obtained with obliquely planned slices. A greater error is indicated when measuring multiple (possibly tortuous or obliquely planned) smaller LSAs in one scan using one-directional single-slice PC MRI.
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Affiliation(s)
- Marieke van den Kerkhof
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Electrical Engineering, University of Eindhoven, PO Box 513, 5600 MB Eindhoven, the Netherlands
| | - Robert J van Oostenbrugge
- School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands; School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
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Chan MYM, Ling YT, Chen XY, Chan ST, Kwong KK, Zheng YP. Success Rate of Transcranial Doppler Scanning of Cerebral Arteries at Different Transtemporal Windows in Healthy Elderly Individuals. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:588-598. [PMID: 36400675 DOI: 10.1016/j.ultrasmedbio.2022.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
This study measured the rates of success in applying transcranial Doppler (TCD) scanning at the middle, posterior and anterior temporal windows (MTW, PTW and ATW) in the elderly. A hand-held 1.6-MHz pulsed-wave TCD transducer was used to search for cerebral arteries at MTW, PTW and ATW locations. Physical attributes of the head, including head circumference and the distance between tragi on both sides ("tragus-to-tragus arc length"), were also measured to explore the associations with successful rates. Among 396 healthy elderly participants (aged 62.6 ± 6.0 y, 140 men), 81.1% (n = 321; 127 men) had one or more temporal windows penetrable by TCD ultrasound (n = 286 [72.2%] at MTW, n = 195 [49.2%] at PTW and n = 106 [26.8%] at ATW). Regression analysis revealed that successful scanning increased significantly in male participants at three window locations. Younger age significantly increased successful scanning at the MTW and ATW. Smaller tragus-to-tragus arc length increased successful scanning at the MTW, but unsuccessful scanning at the ATW. Our findings support using MTW as the first location when positioning the TCD transducer for the scanning of cerebral arteries in the elderly population. When performing TCD scanning on two temporal windows, we propose choosing the MTW and PTW.
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Affiliation(s)
- Mandy Yuen-Man Chan
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Yan To Ling
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Xiang-Yan Chen
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, China; Research Institute for Smart Ageing, Hong Kong Polytechnic University, Hong Kong, China
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Kenneth K Kwong
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China; Research Institute for Smart Ageing, Hong Kong Polytechnic University, Hong Kong, China.
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11
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Shen Y, van der Harst JJ, Wei Y, Bokkers RPH, van Dijk JMC, Uyttenboogaart M. Validation of a cerebral hemodynamic model with personalized calibration in patients with aneurysmal subarachnoid hemorrhage. Front Bioeng Biotechnol 2022; 10:1031600. [PMID: 36507259 PMCID: PMC9732662 DOI: 10.3389/fbioe.2022.1031600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
This study aims to validate a numerical model developed for assessing personalized circle of Willis (CoW) hemodynamics under pathological conditions. Based on 66 computed tomography angiography images, investigations were obtained from 43 acute aneurysmal subarachnoid hemorrhage (aSAH) patients from a local neurovascular center. The mean flow velocity of each artery in the CoW measured using transcranial Doppler (TCD) and simulated by the numerical model was obtained for comparison. The intraclass correlation coefficient (ICC) over all cerebral arteries for TCD and the numerical model was 0.88 (N = 561; 95% CI 0.84-0.90). In a subgroup of patients who had developed delayed cerebral ischemia (DCI), the ICC had decreased to 0.72 but remained constant with respect to changes in blood pressure, Fisher grade, and location of ruptured aneurysm. Our numerical model showed good agreement with TCD in assessing the flow velocity in the CoW of patients with aSAH. In conclusion, the proposed model can satisfactorily reproduce the cerebral hemodynamics under aSAH conditions by personalizing the numerical model with TCD measurements. Clinical trial registration: [http://www.trialregister.nl/], identifier [NL8114].
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Affiliation(s)
- Yuanyuan Shen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. Joep van der Harst
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Yanji Wei
- Eastern Institute for Advanced Study, Yongriver Institute of Technology, Ningbo, China
| | - Reinoud P. H. Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands,Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands,*Correspondence: Maarten Uyttenboogaart,
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12
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Mahinrad S, Tan CO, Ma Y, Aristova M, Milstead AL, Lloyd‐Jones D, Schnell S, Markl M, Sorond FA. Intracranial Blood Flow Quantification by Accelerated Dual-venc 4D Flow MRI: Comparison With Transcranial Doppler Ultrasound. J Magn Reson Imaging 2022; 56:1256-1264. [PMID: 35146822 PMCID: PMC9363520 DOI: 10.1002/jmri.28115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dual-venc 4D flow MRI, recently introduced for the assessment of intracranial hemodynamics, may provide a promising complementary approach to well-established tools such as transcranial Doppler ultrasound (TCD) and overcome some of their disadvantages. However, data comparing intracranial flow measures from dual-venc 4D flow MRI and TCD are lacking. PURPOSE To compare cerebral blood flow velocity measures derived from dual-venc 4D flow MRI and TCD. STUDY TYPE Prospective cohort. SUBJECTS A total of 25 healthy participants (56 ± 4 years old, 44% female). FIELD STRENGTH/SEQUENCE A 3 T/dual-venc 4D flow MRI using a time-resolved three-dimensional phase-contrast sequence with three-dimensional velocity encoding. ASSESSMENT Peak velocity measurements in bilateral middle cerebral arteries (MCA) were quantified from dual-venc 4D flow MRI and TCD. The MRI data were quantified by two independent observers (S.M and Y.M.) and TCD was performed by a trained technician (A.L.M.). We assessed the agreement between 4D flow MRI and TCD measures, and the interobserver agreement of 4D flow MRI measurements. STATISTICAL TESTS Peak velocity from MRI and TCD was compared using Bland-Altman analysis and coefficient of variance. Intraclass correlation coefficient (ICC) was used to assess MRI interobserver agreement. A P value < 0.05 was considered statistically significant. RESULTS There was excellent interobserver agreement in dual-venc 4D flow MRI-based measurements of peak velocity in bilateral MCA (ICC = 0.97 and 0.96 for the left and right MCA, respectively). Dual-venc 4D flow MRI significantly underestimated peak velocity in the left and right MCA compared to TCD (bias = 0.13 [0.59, -0.33] m/sec and 0.15 [0.47, -0.17] m/sec, respectively). The coefficient of variance between dual-venc 4D flow MRI and TCD measurements was 26% for the left MCA and 22% for the right MCA. DATA CONCLUSION There was excellent interobserver agreement for the assessment of MCA peak velocity using dual-venc 4D flow MRI, and ≤20% under-estimation compared with TCD. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Simin Mahinrad
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Can Ozan Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cerebrovascular Research LaboratorySpaulding Rehabilitation HospitalBostonMassachusettsUSA
- Department of RadiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Yue Ma
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of RadiologyShengjing Hospital of China Medical UniversityChina
| | - Maria Aristova
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Andrew L. Milstead
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Donald Lloyd‐Jones
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Susanne Schnell
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Institute of Physics, Department of Medical PhysicsUniversity of GreifswaldGermany
| | - Michael Markl
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinoisUSA
| | - Farzaneh A. Sorond
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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13
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Gao X, Hsieh YL, Wang X, Wang W. Retroauricular/Transcranial Color-Coded Doppler Ultrasound Approach in Junction With Ipsilateral Neck Compression on Real-Time Hydroacoustic Variation of Venous Pulsatile Tinnitus. Front Hum Neurosci 2022; 16:862420. [PMID: 35782046 PMCID: PMC9240288 DOI: 10.3389/fnhum.2022.862420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/12/2022] [Indexed: 12/22/2022] Open
Abstract
Alterations in dural venous sinus hemodynamics have recently been suggested as the major contributing factors in venous pulsatile tinnitus (PT). Nevertheless, little is known about the association between real-time alterations in hemodynamics and the subjective perception of venous PT. This study aimed to investigate the hydroacoustic correlations among diverticular vortices, mainstream sinus flow, and PT using various Doppler ultrasound techniques. Nineteen venous PT patients with protrusive diverticulum were recruited. The mainstream sinus and diverticular hemodynamics before and after ipsilateral internal jugular vein (IJV) compression were investigated using an innovative retroauricular color-coded Doppler (RCCD) method to examine the correlation between the disappearance of PT and hemodynamic alterations. To reveal the hydroacoustic characteristics of disparate segments of venous return, a computational fluid dynamics (CFD) technique combined with the transcranial color-coded Doppler method was performed. When the ipsilateral IJV was compressed, PT disappeared, as the mean velocity of mainstream sinus flow and diverticular vortex decreased by 51.2 and 50.6%, respectively. The vortex inside the diverticulum persisted in 18 of 19 subjects. The CFD simulation showed that the flow amplitude generated inside the transverse–sigmoid sinus was segmental, and the largest flow amplitude difference was 20.5 dB. The difference in flow amplitude between the mainstream sinus flow and the diverticular flow was less than 1 dB. In conclusion, the sensation of PT is closely associated with the flow of kinetic energy rather than the formation of a vortex, whereby the amplitude of PT is correlated to the magnitude of the flow velocity and pressure gradient. Additionally, the range of velocity reduction revealed by the RCCD method may serve as a presurgical individual baseline curative marker that may potentially optimize the surgical outcomes.
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Affiliation(s)
- Xiuli Gao
- Department of Radiology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Yue-Lin Hsieh
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Shanghai, China
| | - Xing Wang
- School of Mechanical and Automotive Engineering, Xiamen University of Technology, Xiamen, China
| | - Wuqing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Shanghai, China
- *Correspondence: Wuqing Wang,
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14
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Pacheco DRQ. On the numerical treatment of viscous and convective effects in relative pressure reconstruction methods. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3562. [PMID: 34873867 PMCID: PMC9286393 DOI: 10.1002/cnm.3562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 06/13/2023]
Abstract
The mechanism of many cardiovascular diseases can be understood by studying the pressure distribution in blood vessels. Direct pressure measurements, however, require invasive probing and provide only single-point data. Alternatively, relative pressure fields can be reconstructed from imaging-based velocity measurements by considering viscous and inertial forces. Both contributions can be potential troublemakers in pressure reconstruction: the former due to its higher-order derivatives, and the latter because of the quadratic nonlinearity in the convective acceleration. Viscous and convective terms can be treated in various forms, which, although equivalent for ideal measurements, can perform differently in practice. In fact, multiple versions are often used in literature, with no apparent consensus on the more suitable variants. In this context, the present work investigates the performance of different versions of relative pressure estimators. For viscous effects, in particular, two new modified estimators are presented to circumvent second-order differentiation without requiring surface integrals. In-silico and in-vitro data in the typical regime of cerebrovascular flows are considered, allowing a systematic noise sensitivity study. Convective terms are shown to be the main source of error, even for flows with pronounced viscous component. Moreover, the conservation (often integrated) form of convection exhibits higher noise sensitivity than the standard convective description, in all three families of estimators considered here. For the classical pressure Poisson estimator, the present modified version of the viscous term tends to yield better accuracy than the (recently introduced) integrated form, although this effect is in most cases negligible when compared to convection-related errors.
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Affiliation(s)
- Douglas R. Q. Pacheco
- Institute of Applied MathematicsGraz University of TechnologyGrazAustria
- Present address:
Graz Center of Computational EngineeringGraz University of TechnologyGrazAustria
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15
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Peng C, Liu J, He W, Qin W, Yuan T, Kan Y, Wang K, Wang S, Shi Y. Numerical simulation in the abdominal aorta and the visceral arteries with or without stenosis based on 2D PCMRI. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3569. [PMID: 34967124 DOI: 10.1002/cnm.3569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
It is important to obtain accurate boundary conditions (BCs) in hemodynamic simulations. This article aimed to improve the accuracy of BCs in computational fluid dynamics (CFD) simulation and analyze the differences in hemodynamics between healthy volunteers and patients with visceral arterial stenosis (VAS). The geometric models of seven cases were reconstructed using the magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA) imaging data. The physiological flow waveforms obtained from 2D Phase Contrast Magnetic Resonance Imaging (PCMRI) were imposed on the aortic inlet and the visceral arteries' outlets. The individualized RCR values of the three-element Windkessel model were imposed on the aortic outlet. CFD simulations were run in the open-source software: svSolver. Two specific time points were selected to compare the hemodynamics of healthy volunteers and patients with VAS. The results suggested that blood in the stenotic visceral arteries flowed at high speed throughout the cardiac cycle. The low pressure is distributed at stenotic lesions. The wall shear stress (WSS) reached 4 Pa near stenotic locations. The low time average wall shear stress (TAWSS), high oscillatory shear index (OSI), and high relative residence time (RRT) concentrated in the abdominal aorta. Besides, the ratios of the areas with low TAWSS, high OSI, and high RRT to the computational domain were higher in patients with VAS than which in the healthy volunteers. The individualized BCs were used for hemodynamic simulations and results suggest that patients with stenosis have a higher risk of blood retention and atherosclerosis formation in the abdominal aorta.
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Affiliation(s)
- Chen Peng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Junzhen Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Qin
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Keqiang Wang
- Institute of Panvascular Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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16
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Dmytriw AA, Bickford S, Pezeshkpour P, Ha W, Amirabadi A, Dibas M, Kitamura LA, Vidarsson L, Pulcine E, Muthusami P. Rotational Vertebrobasilar Insufficiency: Is There a Physiological Spectrum? Phase-Contrast Magnetic Resonance Imaging Quantification in Healthy Volunteers. Pediatr Neurol 2022; 128:58-64. [PMID: 35101804 DOI: 10.1016/j.pediatrneurol.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some cases of cerebral ischemia have been attributed to dynamic flow limitation in neck vessels. It however remains unknown whether this represents the extreme end of a physiological response. METHODS Eighteen healthy volunteers were recruited to this prospective study. Cervical blood flow (ml/min/m2) was assessed using phase-contrast MRI, and cerebral perfusion ratios were assessed using arterial spin labeling perfusion at neutral position, predefined head rotations, as well as flexion and extension. Inter-reader agreements were assessed using intraclass correlation coefficient. RESULTS The mean age was 38.6 ± 10.8 (range = 22-56) years, for five male participants and 13 females. The means for height and weight were 168 cm and 73.2 kg, respectively. There were no significant differences in individual arterial blood flow with change in head position (P > 0.05). Similarly, the repeated-measures analysis of variance test demonstrated no significant difference in perfusion ratios in relation to head position movement (P > 0.05). Inter-reader agreement was excellent (intraclass correlation coefficient = 0.97). CONCLUSIONS There is neither significant change in either individual cervical arterial blood flow nor cerebral perfusion within the normal physiological/anatomical range of motion in healthy individuals. It is therefore reasonable to conclude that any such hemodynamic change identified in a patient with ischemic stroke be considered causative.
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Affiliation(s)
- Adam A Dmytriw
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Suzanne Bickford
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Parneyan Pezeshkpour
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Winston Ha
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Dibas
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Lee Ann Kitamura
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Logi Vidarsson
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Pulcine
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
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17
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Isoda H, Fukuyama A. Quality Control for 4D Flow MR Imaging. Magn Reson Med Sci 2022; 21:278-292. [PMID: 35197395 PMCID: PMC9680545 DOI: 10.2463/mrms.rev.2021-0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 01/06/2023] Open
Abstract
In recent years, 4D flow MRI has become increasingly important in clinical applications for the blood vessels in the whole body, heart, and cerebrospinal fluid. 4D flow MRI has advantages over 2D cine phase-contrast (PC) MRI in that any targeted area of interest can be analyzed post-hoc, but there are some factors to be considered, such as ensuring measurement accuracy, a long imaging time and post-processing complexity, and interobserver variability.Due to the partial volume phenomenon caused by low spatial and temporal resolutions, the accuracy of flow measurement in 4D flow MRI is reduced. For spatial resolution, it is recommended to include at least four voxels in the vessel of interest, and if possible, six voxels. In large vessels such as the aorta, large voxels can be secured and SNR can be maintained, but in small cerebral vessels, SNR is reduced, resulting in reduced accuracy. A temporal resolution of less than 40 ms is recommended. The velocity-to-noise ratio (VNR) of low-velocity blood flow is low, resulting in poor measurement accuracy. The use of dual velocity encoding (VENC) or multi-VENC is recommended to avoid velocity wrap around and to increase VNR. In order to maintain sufficient spatio-temporal resolution, a longer imaging time is required, leading to potential patient movement during examination and a corresponding decrease in measurement accuracy.For the clinical application of new technologies, including various acceleration techniques, in vitro and in vivo accuracy verification based on existing accuracy-validated 2D cine PC MRI and 4D flow MRI, as well as accuracy verification on the conservation of mass' principle, should be performed, and intraobserver repeatability, interobserver reproducibility, and test-retest reproducibility should be checked.
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Affiliation(s)
- Haruo Isoda
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Biomedical Imaging Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Atsushi Fukuyama
- Faculty of Health Sciences, Department of Radiological Sciences, Japan Healthcare University, Sapporo, Hokkaido, Japan
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18
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Abstract
Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time-resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health. The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain-wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow-up of interventions aiming to restore a normal cerebral circulation. Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest.
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Affiliation(s)
- Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science and Neurosciences, Umeå University, Umeå, Sweden
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19
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Ha SY, Kang Y, Lee HJ, Hwang M, Baik J, Park S. Intracranial Flow Velocity Quantification Using Non-Contrast Four-Dimensional Flow MRI: A Prospective Comparative Study with Transcranial Doppler Ultrasound. Diagnostics (Basel) 2021; 12:diagnostics12010023. [PMID: 35054190 PMCID: PMC8774649 DOI: 10.3390/diagnostics12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Four-dimensional (4D) flow magnetic resonance imaging (MRI) allows three-dimensional velocity encoding to measure blood flow in a single scan, regardless of the intracranial artery direction. We compared blood flow velocity quantification by non-contrast 4D flow MRI and by transcranial Doppler ultrasound (TCD), the most widely used modality for measuring velocity. Twenty-two patients underwent both TCD and non-contrast 4D flow MRI. The mean time interval between TCD and non-contrast 4D flow MRI was 0.7 days. Subsegmental velocities were measured bilaterally in the middle cerebral and basilar arteries using TCD and non-contrast 4D flow MRI. Intracranial velocity measurements using TCD and non-contrast 4D flow MRI demonstrated a strong correlation in the bilateral M1, especially at the proximal segment (right r = 0.74, left r = 0.78; all p < 0.001). Mean velocities acquired with 4D flow MRI were approximately 8 to 10% lower than those acquired with TCD according to the location of M1. Intracranial arterial flow measurements estimated using non-contrast 4D flow MRI and TCD showed strong correlation. 4D flow MRI enables simultaneous assessment of vascular morphology and quantitative hemodynamic measurement, providing three-dimensional blood flow visualization. 4D flow MRI is a clinically useful sequence with a promising role in cerebrovascular disease.
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Affiliation(s)
- Sam-Yeol Ha
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (S.-Y.H.); (S.P.)
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Yeonah Kang
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (H.-J.L.); (J.B.)
- Correspondence: ; Tel.: +82-51-797-0340; Fax: +82-51-797-0379
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (H.-J.L.); (J.B.)
| | | | - Jiyeon Baik
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (H.-J.L.); (J.B.)
- Department of Radiology, Good Gang-An Hospital, Busan 48265, Korea
| | - Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea; (S.-Y.H.); (S.P.)
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20
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Secchi F, Monti CB, Capra D, Vitale R, Mazzaccaro D, Conti M, Jin N, Giese D, Nano G, Sardanelli F, Marrocco-Trischitta MM. Carotid Phase-Contrast Magnetic Resonance before Treatment: 4D-Flow versus Standard 2D Imaging. Tomography 2021; 7:513-522. [PMID: 34698250 PMCID: PMC8544659 DOI: 10.3390/tomography7040044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate the level of agreement between flow/velocity data obtained from 2D-phase-contrast (PC) and 4D-flow in patients scheduled for treatment of carotid artery stenosis. Image acquisition was performed using a 1.5 T scanner. We compared mean flow rates, vessel areas, and peak velocities obtained during the acquisition with both techniques in 20 consecutive patients, 15 males and 5 females aged 69 ± 5 years (mean ± standard deviation). There was a good correlation between both techniques for the CCA flow (r = 0.65, p < 0.001), whereas for the ICA flow and ECA flow the correlation was only moderate (r = 0.4, p = 0.011 and r = 0.45, p = 0.003, respectively). Correlations of peak velocities between methods were good for CCA (r = 0.56, p < 0.001) and moderate for ECA (r = 0.41, p = 0.008). There was no correlation for ICA (r = 0.04, p = 0.805). Cross-sectional area values between methods showed no significant correlations for CCA (r = 0.18, p = 0.269), ICA (r = 0.1, p = 0.543), and ECA (r = 0.05, p = 0.767). Conclusion: the 4D-flow imaging provided a good correlation of CCA and a moderate correlation of ICA flow rates against 2D-PC, underestimating peak velocities and overestimating cross-sectional areas in all carotid segments.
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Affiliation(s)
- Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
| | - Renato Vitale
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
| | - Daniela Mazzaccaro
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (D.M.); (M.M.M.-T.)
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy;
| | - Ning Jin
- Siemens Medical Solutions USA, Inc., Malvern, PA 19355, USA;
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, 91052 Erlangen, Germany;
| | - Giovanni Nano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (D.M.); (M.M.M.-T.)
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (D.C.); (R.V.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Massimiliano M. Marrocco-Trischitta
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (D.M.); (M.M.M.-T.)
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
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21
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Williams G, Thyagaraj S, Fu A, Oshinski J, Giese D, Bunck AC, Fornari E, Santini F, Luciano M, Loth F, Martin BA. In vitro evaluation of cerebrospinal fluid velocity measurement in type I Chiari malformation: repeatability, reproducibility, and agreement using 2D phase contrast and 4D flow MRI. Fluids Barriers CNS 2021; 18:12. [PMID: 33736664 PMCID: PMC7977612 DOI: 10.1186/s12987-021-00246-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/03/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Phase contrast magnetic resonance imaging, PC MRI, is a valuable tool allowing for non-invasive quantification of CSF dynamics, but has lacked adoption in clinical practice for Chiari malformation diagnostics. To improve these diagnostic practices, a better understanding of PC MRI based measurement agreement, repeatability, and reproducibility of CSF dynamics is needed. METHODS An anatomically realistic in vitro subject specific model of a Chiari malformation patient was scanned three times at five different scanning centers using 2D PC MRI and 4D Flow techniques to quantify intra-scanner repeatability, inter-scanner reproducibility, and agreement between imaging modalities. Peak systolic CSF velocities were measured at nine axial planes using 2D PC MRI, which were then compared to 4D Flow peak systolic velocity measurements extracted at those exact axial positions along the model. RESULTS Comparison of measurement results showed good overall agreement of CSF velocity detection between 2D PC MRI and 4D Flow (p = 0.86), fair intra-scanner repeatability (confidence intervals ± 1.5 cm/s), and poor inter-scanner reproducibility. On average, 4D Flow measurements had a larger variability than 2D PC MRI measurements (standard deviations 1.83 and 1.04 cm/s, respectively). CONCLUSION Agreement, repeatability, and reproducibility of 2D PC MRI and 4D Flow detection of peak CSF velocities was quantified using a patient-specific in vitro model of Chiari malformation. In combination, the greatest factor leading to measurement inconsistency was determined to be a lack of reproducibility between different MRI centers. Overall, these findings may help lead to better understanding for application of 2D PC MRI and 4D Flow techniques as diagnostic tools for CSF dynamics quantification in Chiari malformation and related diseases.
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Affiliation(s)
- Gwendolyn Williams
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844, USA
| | - Suraj Thyagaraj
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, 44325, USA
| | - Audrey Fu
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, ID, 83844, USA
| | - John Oshinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA
| | - Daniel Giese
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Eleonora Fornari
- CIBM, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Francesco Santini
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Mark Luciano
- Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA
| | - Francis Loth
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, 44325, USA
| | - Bryn A Martin
- Department of Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MC1122, Moscow, ID, 83844, USA.
- Alcyone Therapeutics Inc, Lowell, MA, USA.
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22
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Li X, Qiu X, Ding H, Lv H, Zhao P, Yang Z, Gong S, Wang Z. Effects of different morphologic abnormalities on hemodynamics in patients with venous pulsatile tinnitus: A four-dimensional flow magnetic resonance imaging study. J Magn Reson Imaging 2021; 53:1744-1751. [PMID: 33491233 PMCID: PMC8248416 DOI: 10.1002/jmri.27503] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/18/2022] Open
Abstract
The effects of morphologic abnormalities, including sigmoid sinus wall dehiscence (SSWD), transverse sinus stenosis (TSS), and sigmoid sinus diverticulum (SSD), on hemodynamics in venous pulsatile tinnitus (PT) patients have not been established. The aim of this study was to evaluate the effects of SSWD, TSS, and SSD on the hemodynamics of transverse‐sigmoid sinus in venous PT patients. This was a prospective study with 44 venous PT patients and 12 healthy controls. A 3 T/four‐dimensional (4D) flow magnetic resonance imaging with fast field echo was used. Computed tomography arteriography/venography was used to assess ipsilateral SSWD, TSS, and SSD. Maximum velocity (Vmax), average velocity (Vavg), and average flow (Flowavg) were measured. Blood flow patterns were independently assessed by three neuroradiologists. One‐way analysis of variance or Kruskal–Wallis test was also used. On the symptomatic side, all patients had SSWD, 33 patients had TSS, and 22 patients had SSD. Compared with healthy controls, patients with TSS, without TSS, with SSD, and without SSD all showed higher Vmax (all p < 0.050), Vavg (all p < 0.050), and Flowavg (all p < 0.050). Patients with TSS showed higher Vmax (p < 0.050) and Vavg (p < 0.050) than those without TSS, and no significant difference in Flowavg was found between the two groups (p = 0.408). No significant differences in Vmax, Vavg, and Flowavg were found between patients with and without SSD (all p = 1.000). Jet‐like flow in the stenosis and downstream of the stenosis was observed in all patients with TSS. Vortex in SSD was observed in 15 patients with SSD (68%). High blood velocity and flow may be characteristic markers of venous PT. SSWD may be a necessary condition for venous PT. TSS may further increase the blood velocity and form a jet‐like flow. SSD may be related to vortex formation but had no significant effect on blood velocity and flow. Level of Evidence 2 Technical Efficacy Stage 3
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Affiliation(s)
- Xiaoshuai Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Qiu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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23
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Srinivas S, Retson T, Simon A, Hattangadi-Gluth J, Hsiao A, Farid N. Quantification of hemodynamics of cerebral arteriovenous malformations after stereotactic radiosurgery using 4D flow magnetic resonance imaging. J Magn Reson Imaging 2020; 53:1841-1850. [PMID: 33354852 DOI: 10.1002/jmri.27490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022] Open
Abstract
Stereotactic radiosurgery (SRS) is used to treat cerebral arteriovenous malformations (AVMs). However, early evaluation of efficacy is difficult as structural magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) often does not demonstrate appreciable changes within the first 6 months. The aim of this study was to evaluate the use of four-dimensional (4D) flow MRI to quantify hemodynamic changes after SRS as early as 2 months. This was a retrospective observational study, which included 14 patients with both pre-SRS and post-SRS imaging obtained at multiple time points from 1 to 27 months after SRS. A 3T MRI Scanner was used to obtain T2 single-shot fast spin echo, time-of-flight MRA, and postcontrast 4D flow with three-dimensional velocity encoding between 150 and 200 cm/s. Post-hoc two-dimensional cross-sectional flow was measured for the dominant feeding artery, the draining vein, and the corresponding contralateral artery as a control. Measurements were performed by two independent observers, and reproducibility was assessed. Wilcoxon signed-rank tests were used to compare differences in flow, circumference, and pulsatility between the feeding artery and the contralateral artery both before and after SRS; and differences in nidus size and flow and circumference of the feeding artery and draining vein before and after SRS. Arterial flow (L/min) decreased in the primary feeding artery (mean: 0.1 ± 0.07 vs. 0.3 ± 0.2; p < 0.05) and normalized in comparison to the contralateral artery (mean: 0.1 ± 0.07 vs. 0.1 ± 0.07; p = 0.068). Flow decreased in the draining vein (mean: 0.1 ± 0.2 vs. 0.2 ± 0.2; p < 0.05), and the circumference of the draining vein also decreased (mean: 16.1 ± 8.3 vs. 15.7 ± 6.7; p < 0.05). AVM volume decreased after SRS (mean: 45.3 ± 84.8 vs. 38.1 ± 78.7; p < 0.05). However, circumference (mm) of the primary feeding artery remained similar after SRS (mean: 15.7 ± 2.7 vs. 16.1 ± 3.1; p = 0.600). 4D flow may be able to demonstrate early hemodynamic changes in AVMs treated with radiosurgery, and these changes appear to be more pronounced and occur earlier than the structural changes on standard MRI/MRA. Level of Evidence: 4 Technical Efficacy Stage: 1.
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Affiliation(s)
- Shanmukha Srinivas
- Department of Radiology, University of California-San Diego, San Diego, California, USA
| | - Tara Retson
- Department of Radiology, University of California-San Diego, San Diego, California, USA
| | - Aaron Simon
- Department of Radiation Medicine and Applied Sciences, University of California-San Diego, San Diego, California, USA
| | - Jona Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California-San Diego, San Diego, California, USA
| | - Albert Hsiao
- Department of Radiology, University of California-San Diego, San Diego, California, USA
| | - Nikdokht Farid
- Department of Radiology, University of California-San Diego, San Diego, California, USA
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24
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Youn SW, Lee J. From 2D to 4D Phase-Contrast MRI in the Neurovascular System: Will It Be a Quantum Jump or a Fancy Decoration? J Magn Reson Imaging 2020; 55:347-372. [PMID: 33236488 DOI: 10.1002/jmri.27430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Considering the crosstalk between the flow and vessel wall, hemodynamic assessment of the neurovascular system may offer a well-integrated solution for both diagnosis and management by adding prognostic significance to the standard CT/MR angiography. 4D flow MRI or time-resolved 3D velocity-encoded phase-contrast MRI has long been promising for the hemodynamic evaluation of the great vessels, but challenged in clinical studies for assessing intracranial vessels with small diameter due to long scan times and low spatiotemporal resolution. Current accelerated MRI techniques, including parallel imaging with compressed sensing and radial k-space undersampling acquisitions, have decreased scan times dramatically while preserving spatial resolution. 4D flow MRI visualized and measured 3D complex flow of neurovascular diseases such as aneurysm, arteriovenous shunts, and atherosclerotic stenosis using parameters including flow volume, velocity vector, pressure gradients, and wall shear stress. In addition to the noninvasiveness of the phase contrast technique and retrospective flow measurement through the wanted windows of the analysis plane, 4D flow MRI has shown several advantages over Doppler ultrasound or computational fluid dynamics. The evaluation of the flow status and vessel wall can be performed simultaneously in the same imaging modality. This article is an overview of the recent advances in neurovascular 4D flow MRI techniques and their potential clinical applications in neurovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sung Won Youn
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology and Biomedical Engineering, Kyungpook National University School of Medicine, Daegu, Korea
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25
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Medero R, Falk K, Rutkowski D, Johnson K, Roldán-Alzate A. In Vitro Assessment of Flow Variability in an Intracranial Aneurysm Model Using 4D Flow MRI and Tomographic PIV. Ann Biomed Eng 2020; 48:2484-2493. [PMID: 32524379 PMCID: PMC7821079 DOI: 10.1007/s10439-020-02543-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/01/2020] [Indexed: 01/10/2023]
Abstract
Aneurysm rupture has been suggested to be related to aneurysm geometry, morphology, and complex flow activity; therefore, understanding aneurysm-specific hemodynamics is crucial. 4D Flow MRI has been shown to be a feasible tool for assessing hemodynamics in intracranial aneurysms with high spatial resolution. However, it requires averaging over multiple heartbeats and cannot account for cycle-to-cycle hemodynamics variations. This study aimed to assess cycle-to-cycle flow dynamics variations in a patient-specific intracranial aneurysm model using tomographic particle image velocimetry (tomo-PIV) at a high image rate under pulsatile flow conditions. Time-resolved and time-averaged velocity flow fields within the aneurysm sac and estimations of wall shear stress (WSS) were compared with those from 4D Flow MRI. A one-way ANOVA showed a significant difference between cardiac cycles (p value < 0.0001); however, differences were not significant after PIV temporal and spatial resolution was matched to that of MRI (p value 0.9727). This comparison showed the spatial resolution to be the main contributor to assess cycle-to-cycle variability. Furthermore, the comparison with 4D Flow MRI between velocity components, streamlines, and estimated WSS showed good qualitative and quantitative agreement. This study showed the feasibility of patient-specific in-vitro experiments using tomo-PIV to assess 4D Flow MRI with high repeatability in the measurements.
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Affiliation(s)
- Rafael Medero
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, WIMR 2476, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Katrina Falk
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - David Rutkowski
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, WIMR 2476, 1111 Highland Ave, Madison, WI, 53705, USA
| | - Kevin Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Radiology, University of Wisconsin-Madison, WIMR 2476, 1111 Highland Ave, Madison, WI, 53705, USA.
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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26
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MacDonald CJ, Hellmuth R, Priba L, Murphy E, Gandy S, Matthew S, Ross R, Houston JG. Experimental Assessment of Two Non-Contrast MRI Sequences Used for Computational Fluid Dynamics: Investigation of Consistency Between Techniques. Cardiovasc Eng Technol 2020; 11:416-430. [PMID: 32613600 PMCID: PMC7385008 DOI: 10.1007/s13239-020-00473-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/20/2020] [Indexed: 11/05/2022]
Abstract
Purpose Recent studies have noted a degree of variance between the geometries segmented by different groups from 3D medical images that are used in computational fluid dynamics (CFD) simulations of patient-specific cardiovascular systems. The aim of this study was to determine if the applied sequence of magnetic resonance imaging (MRI) also introduced observable variance in CFD results. Methods Using a series of phantoms MR images of vessels of known diameter were assessed for the time-of-flight and multi-echo data image combination sequences. Following this, patient images of arterio-venous fistulas were acquired using the same sequences. Comparisons of geometry were made using the phantom and patient images, and of wall shear stress quantities using the CFD results from the patient images. Results Phantom images showed deviations in diameter between 0 and 15% between the sequences, depending on vessel diameter. Patient images showed different geometrical features such as narrowings that were not present on both sequences. Distributions of wall shear stress (WSS) quantities differed from simulations between the geometries obtained from the sequences. Conclusion In conclusion, choosing different MRI sequences resulted in slightly different geometries of the same anatomy, which led to compounded errors in WSS quantities from CFD simulation. Electronic supplementary material The online version of this article (10.1007/s13239-020-00473-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C J MacDonald
- Imaging and Technology, University of Dundee, Dundee, UK
| | - R Hellmuth
- Vascular Flow Technologies LTD, Dundee, UK
| | - L Priba
- Medical Physics, NHS Tayside, Dundee, UK
| | - E Murphy
- Imaging and Technology, University of Dundee, Dundee, UK
| | - S Gandy
- Medical Physics, NHS Tayside, Dundee, UK
| | - S Matthew
- Imaging and Technology, University of Dundee, Dundee, UK
| | - R Ross
- Vascular Laboratory, NHS Tayside, Dundee, UK
| | - J G Houston
- Imaging and Technology, University of Dundee, Dundee, UK. .,Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK.
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27
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Jahed M, Ghalichi F, Farhoudi M. Comparison of blood velocity between Transcranial Doppler and numerical method in the patient-specific Circle of Willis with aneurysm. Biomed Mater Eng 2019; 30:427-438. [PMID: 31561321 DOI: 10.3233/bme-191064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The development of any disturbance in the Circle of Willis (COW) can change the hemodynamics of blood flow and result in damage to the vascular system. Clinical methods such as TCD for diagnosing an aneurysm or growth factors and rupture can measure blood velocity. Several factors influence the accuracy of TCD that can lead to wrong evaluations and affect the treatment planning. OBJECTIVE In this study, the conformity between CFD and TCD was accomplished for investigating the accuracy of the clinical method (TCD) in different vessels of the Circle of Willis. METHODS The realistic three-dimensional models have been produced from angiography images. Considering fluid-structure interaction, a domain of the blood flow and vessel wall has been simulated by the ANSYS.CFX software. The velocity in the cerebral arteries has been calculated and compared with the velocity acquired from TCD. RESULTS According to the findings, there were significant differences between the results obtained from computational fluid dynamics and Doppler test in different vessels of the Circle of Willis. In some areas, differences close to 80 cm/s were also reported. CONCLUSION According to the results, there are possibilities of errors in carrying out a Doppler test in some arteries and can lead to wrong estimates and ultimately incorrect decisions.
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Affiliation(s)
- Mahsa Jahed
- Biomedical Engineering Department, Division of Biomechanics, Sahand University of Technology, Tabriz, Iran
| | - Farzan Ghalichi
- Biomedical Engineering Department, Division of Biomechanics, Sahand University of Technology, Tabriz, Iran
| | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Science, Tabriz, Iran
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28
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Ebel S, Hübner L, Köhler B, Kropf S, Preim B, Jung B, Grothoff M, Gutberlet M. Validation of two accelerated 4D flow MRI sequences at 3 T: a phantom study. Eur Radiol Exp 2019; 3:10. [PMID: 30806827 PMCID: PMC6391502 DOI: 10.1186/s41747-019-0089-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background Four-dimensional (4D) flow magnetic resonance imaging (MRI) sequences with advanced parallel imaging have the potential to reduce scan time with equivalent image quality and accuracy compared with standard two-dimensional (2D) flow MRI. We compared 4D flow to standard 2D flow sequences using a constant and pulsatile flow phantom at 3 T. Methods Two accelerated 4D flow sequences (GRAPPA2 and k-t-GRAPPA5) were evaluated regarding the concordance of flow volumes, flow velocities, and reproducibility as well as dependency on measuring plane and velocity encoding (Venc). The calculated flow volumes and peak velocities of the phantom were used as reference standard. Flow analysis was performed using the custom-made software “Bloodline”. Results No significant differences in flow volume were found between the 2D, both 4D flow MRI sequences, and the pump reference (p = 0.994) or flow velocities (p = 0.998) in continuous and pulsatile flow. An excellent correlation (R = 0.99–1.0) with a reference standard and excellent reproducibility of measurements (R = 0.99) was achieved for all sequences. A Venc overestimated by up to two times had no impact on flow measurements. However, misaligned measuring planes led to an increasing underestimation of flow volume and mean velocity in 2D flow accuracy, while both 4D flow measurements were not affected. Scan time was significantly shorter for k-t-GRAPPA5 (1:54 ± 0:01 min, mean ± standard deviation) compared to GRAPPA2 (3:56 ± 0:02 min) (p = 0.002). Conclusions Both 4D flow sequences demonstrated equal agreement with 2D flow measurements, without impact of Venc overestimation and plane misalignment. The highly accelerated k-t-GRAPPA5 sequence yielded results similar to those of GRAPPA2.
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Affiliation(s)
- Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig Strümpellstrasse 39, 04289, Leipzig, Germany.
| | - Lisa Hübner
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Benjamin Köhler
- Department of Simulations and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Siegfried Kropf
- Institute for Biometrics and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Bernhard Preim
- Department of Simulations and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Bern, Switzerland
| | - Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig Strümpellstrasse 39, 04289, Leipzig, Germany
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29
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Dunås T, Holmgren M, Wåhlin A, Malm J, Eklund A. Accuracy of blood flow assessment in cerebral arteries with 4D flow MRI: Evaluation with three segmentation methods. J Magn Reson Imaging 2019; 50:511-518. [PMID: 30637846 PMCID: PMC6767555 DOI: 10.1002/jmri.26641] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background Accelerated 4D flow MRI allows for high‐resolution velocity measurements with whole‐brain coverage. Such scans are increasingly used to calculate flow rates of individual arteries in the vascular tree, but detailed information about the accuracy and precision in relation to different postprocessing options is lacking. Purpose To evaluate and optimize three proposed segmentation methods and determine the accuracy of in vivo 4D flow MRI blood flow rate assessments in major cerebral arteries, with high‐resolution 2D PCMRI as a reference. Study Type Prospective. Subjects Thirty‐five subjects (20 women, 79 ± 5 years, range 70–91 years). Field Strength/Sequence 4D flow MRI with PC‐VIPR and 2D PCMRI acquired with a 3 T scanner. Assessment We compared blood flow rates measured with 4D flow MRI, to the reference, in nine main cerebral arteries. Lumen segmentation in the 4D flow MRI was performed with k‐means clustering using four different input datasets, and with two types of thresholding methods. The threshold was defined as a percentage of the maximum intensity value in the complex difference image. Local and global thresholding approaches were used, with evaluated thresholds from 6–26%. Statistical Tests Paired t‐test, F‐test, linear correlation (P < 0.05 was considered significant) along with intraclass correlation (ICC). Results With the thresholding methods, the lowest average flow difference was obtained for 20% local (0.02 ± 15.0 ml/min, ICC = 0.97, n = 310) or 10% global (0.08 ± 17.3 ml/min, ICC = 0.97, n = 310) thresholding with a significant lower standard deviation for local (F‐test, P = 0.01). For all clustering methods, we found a large systematic underestimation of flow compared with 2D PCMRI (16.1–22.3 ml/min). Data Conclusion A locally adapted threshold value gives a more stable result compared with a globally fixed threshold. 4D flow with the proposed segmentation method has the potential to become a useful reliable clinical tool for assessment of blood flow in the major cerebral arteries. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:511–518.
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Affiliation(s)
- Tora Dunås
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | | | - Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
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30
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The Atheroprotective Nature of Helical Flow in Coronary Arteries. Ann Biomed Eng 2018; 47:425-438. [DOI: 10.1007/s10439-018-02169-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022]
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In-vitro validation of 4D flow MRI measurements with an experimental pulsatile flow model. Diagn Interv Imaging 2018; 100:17-23. [PMID: 30241970 DOI: 10.1016/j.diii.2018.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/05/2018] [Accepted: 08/11/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study was to assess the precision of four-dimensional (4D) phase-contrast magnetic resonance imaging (PCMRI) to measure mean flow and peak velocity (Vmax) in a pulsatile flow phantom and to test its sensitivity to spatial resolution and Venc. MATERIAL AND METHODS The pulsatile flow phantom consisted of a straight tube connected to the systemic circulation of an experimental mock circulatory system. Four-dimensional-PCMR images were acquired using different spatial resolutions (minimum pixel size: 1.5×1.5×1.5mm3) and velocity encoding sensitivities (up to three times Vmax). Mean flow and Vmax calculated from 4D-PCMRI were compared respectively to the reference phantom flow parameters and to Vmax obtained from two-dimensional (2D)-PCMRI. RESULTS 4D-PCI measured mean flow with a precision of -0.04% to+5.46%, but slightly underestimated Vmax when compared to 2D-PCMRI (differences ranging from -1.71% to -3.85%). 4D PCMRI mean flow measurement was influenced by spatial resolution (P<0.001) with better results obtained with smaller voxel size. There was no effect of Venc on mean flow measurement. Regarding Vmax, neither spatial resolution nor Venc did influence the precision of the measurement. CONCLUSION Using an experimental pulsatile flow model 4D-PCMRI is accurate to measure mean flow and Vmax with better results obtained with higher spatial resolution. We also show that Venc up to 3 times higher than Vmax may be used with no effect on these measurements.
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32
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Medero R, Hoffman C, Roldán-Alzate A. Comparison of 4D Flow MRI and Particle Image Velocimetry Using an In Vitro Carotid Bifurcation Model. Ann Biomed Eng 2018; 46:2112-2122. [PMID: 30112708 DOI: 10.1007/s10439-018-02109-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/27/2018] [Indexed: 01/13/2023]
Abstract
Four-dimensional (4D) Flow magnetic resonance imaging (MRI) enables the acquisition and assessment of complex hemodynamics in vivo from different vascular territories. This study investigated the viability of stereoscopic and tomographic particle image velocimetry (stereo- and tomo-PIV, respectively) as experimental validation techniques for 4D Flow MRI. The experiments were performed using continuous and pulsatile flows through an idealized carotid artery bifurcation model. Transverse and longitudinal planes were extracted from the acquired velocity data sets at different regions of interest and were analyzed with a point-by-point comparison. An overall root-mean-square error (RMSE) was calculated resulting in errors as low as 0.06 and 0.03 m/s when comparing 4D Flow MRI with stereo- and tomo-PIV, respectively. Quantitative agreement between techniques was determined by evaluating the relationship for individual velocity components and their magnitudes. These resulted in correlation coefficients (R2) of 4D Flow MRI with stereo- and tomo-PIV, as low as 0.76 and 0.73, respectively. The 3D velocity measurements from PIV showed qualitative agreement when compared to 4D Flow MRI, especially with tomo-PIV due to the addition of volumetric velocity measurements. These results suggest that tomo-PIV can be used as a validation technique for 4D Flow MRI, serving as the basis for future validation protocols.
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Affiliation(s)
- Rafael Medero
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA. .,, 1415 Engineering Drive, Madison, WI, 53706, USA.
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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33
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Groen D, Richardson RA, Coy R, Schiller UD, Chandrashekar H, Robertson F, Coveney PV. Validation of Patient-Specific Cerebral Blood Flow Simulation Using Transcranial Doppler Measurements. Front Physiol 2018; 9:721. [PMID: 29971012 PMCID: PMC6018476 DOI: 10.3389/fphys.2018.00721] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/24/2018] [Indexed: 11/13/2022] Open
Abstract
We present a validation study comparing results from a patient-specific lattice-Boltzmann simulation to transcranial Doppler (TCD) velocity measurements in four different planes of the middle cerebral artery (MCA). As part of the study, we compared simulations using a Newtonian and a Carreau-Yasuda rheology model. We also investigated the viability of using downscaled velocities to reduce the required resolution. Simulations with unscaled velocities predict the maximum flow velocity with an error of less than 9%, independent of the rheology model chosen. The accuracy of the simulation predictions worsens considerably when simulations are run at reduced velocity, as is for example the case when inflow velocities from healthy individuals are used on a vascular model of a stroke patient. Our results demonstrate the importance of using directly measured and patient-specific inflow velocities when simulating blood flow in MCAs. We conclude that localized TCD measurements together with predictive simulations can be used to obtain flow estimates with high fidelity over a larger region, and reduce the need for more invasive flow measurement procedures.
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Affiliation(s)
- Derek Groen
- Department of Computer Science, Brunel University London, London, United Kingdom
| | - Robin A Richardson
- Centre for Computational Science, University College London, London, United Kingdom
| | - Rachel Coy
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom
| | - Ulf D Schiller
- Department of Materials Science and Engineering, Clemson University, Clemson, SC, United States.,School of Health Research, Clemson University, Clemson, SC, United States
| | - Hoskote Chandrashekar
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Fergus Robertson
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Peter V Coveney
- Centre for Computational Science, University College London, London, United Kingdom.,Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom
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34
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Ota H, Higuchi S, Sun W, Ueda T, Takase K, Tamura H. Four-Dimensional Flow Magnetic Resonance Imaging for Cardiovascular Imaging: from Basic Concept to Clinical Application. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Wenyu Sun
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Takuya Ueda
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hajime Tamura
- Division of Medical Physics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Pelvic Blood Flow Predicts Fibroid Volume and Embolic Required for Uterine Fibroid Embolization: A Pilot Study With 4D Flow MR Angiography. AJR Am J Roentgenol 2017; 210:189-200. [PMID: 29090998 DOI: 10.2214/ajr.17.18127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We report here an initial experience using 4D flow MRI in pelvic imaging-specifically, in imaging uterine fibroids. We hypothesized that blood flow might correlate with fibroid volume and that quantifying blood flow might help to predict the amount of embolic required to achieve stasis at subsequent uterine fibroid embolization (UFE). MATERIALS AND METHODS Thirty-three patients with uterine fibroids and seven control subjects underwent pelvic MRI with 4D flow imaging. Of the patients with fibroids, 10 underwent 4D flow imaging before UFE and seven after UFE; in the remaining 16 patients with fibroids, UFE had yet to be performed. Four-dimensional flow measurements were performed using Arterys CV Flow. The flow fraction of the internal iliac artery was expressed as the ratio of internal iliac artery flow to external iliac artery flow and was compared between groups. The flow ratios between the internal iliac arteries on each side were calculated. Fibroid volume versus internal iliac flow fraction, embolic volume versus internal iliac flow fraction, and embolic volume ratio between sides versus the ratio of internal iliac artery flows between sides were compared. RESULTS The mean internal iliac flow fraction was significantly higher in the 26 patients who underwent imaging before UFE (mean ± standard error, 0.78 ± 0.06) than in the seven patients who underwent imaging after UFE (0.48 ± 0.07, p < 0.01) and in the seven control patients without fibroids (0.48 ± 0.08, p < 0.0001). The internal iliac flow fraction correlated well with fibroid volumes before UFE (r = 0.7754, p < 0.0001) and did not correlate with fibroid volumes after UFE (r = -0.3051, p = 0.51). The ratio of embolic required to achieve stasis between sides showed a modest correlation with the ratio of internal iliac flow (r = 0.6776, p = 0.03). CONCLUSION Internal iliac flow measured by 4D flow MRI correlates with fibroid volume and is predictive of the ratio of embolic required to achieve stasis on each side at subsequent UFE and may be useful for preprocedural evaluation of patients with uterine fibroids.
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36
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Viessmann O, Möller HE, Jezzard P. Cardiac cycle-induced EPI time series fluctuations in the brain: Their temporal shifts, inflow effects and T 2∗ fluctuations. Neuroimage 2017; 162:93-105. [PMID: 28864026 PMCID: PMC5711428 DOI: 10.1016/j.neuroimage.2017.08.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/17/2017] [Accepted: 08/25/2017] [Indexed: 12/17/2022] Open
Abstract
The cardiac-induced arterial pressure wave causes changes in cerebral blood flow velocities and volumes that affect the signals in echo-planar imaging (EPI). Using single-echo EPI time series data, acquired fast enough to unalias the cardiac frequency, we found that the cardiac cycle-induced signal fluctuations are delayed differentially in different brain regions. When referenced to the time series in larger arterial structures, the cortical voxels are only minimally shifted but significant shifts are observed in subcortical areas. Using double-echo EPI data we mapped the voxels’ “signal at zero echo time”, S0, and apparent T2∗ over the cardiac cycle. S0 pulsatility was maximised for voxels with a cardiac cycle-induced timing that was close to the arterial structures and is likely explained by enhanced inflow effects in the cortical areas compared to subcortical areas. Interestingly a consistent T2∗ waveform over the cardiac cycle was observed in all voxels with average amplitude ranges between 0.3-0.55% in grey matter and 0.15–0.22% in white matter. The timing of the T2∗ waveforms suggests a partial volume fluctuation where arteriolar blood volume changes are counterbalanced by changes in CSF volumes.
The timing of cardiac cycle-induced fluctuations in EPI time series was measured with fast EPI. Fluctuations are delayed differentially in different brain regions. Cortical voxels are closely matching the timing of arterial structures whereas subcortical voxels are shifted. We used double-echo EPI to map S0 and T2∗ in each voxel over the cardiac cycle. S0 pulsatility varies across voxels but a consistent T2∗ pulsatility was found in all voxels.
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Affiliation(s)
- Olivia Viessmann
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Harald E Möller
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103 Leipzig, Germany.
| | - Peter Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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37
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Sekine T, Takagi R, Amano Y, Murai Y, Orita E, Fukushima Y, Matsumura Y, Kumita SI. 4D Flow MR Imaging of Ophthalmic Artery Flow in Patients with Internal Carotid Artery Stenosis. Magn Reson Med Sci 2017; 17:13-20. [PMID: 28367905 PMCID: PMC5760228 DOI: 10.2463/mrms.mp.2016-0074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: To assess the clinical feasibility of time-resolved 3D phase contrast (4D Flow) MRI assessment of the ophthalmic artery (OphA) flow in patients with internal carotid artery stenosis (ICS). Materials and Methods: Twenty-one consecutive patients with unilateral ICS were recruited. 4D Flow MRI and acetazolamide-stress brain perfusion single photon emission computed tomography (SPECT) were performed. The flow direction on the affected-side OphA was categorized into native flow (anterograde or unclear) and non-native flow (retrograde flow) based on 4D Flow MRI. In the affected-side middle cerebral artery (MCA) territory, the ratio of rest cerebral blood flow to normal control (RCBFMCA) and cerebral vascular reserve (CVRMCA) were calculated from SPECT dataset. High-risk patients were defined based on the previous large cohort study (RCBFMCA < 80% and CVRMCA < 10%). Results: Eleven patients had native OphA flow (4 anterograde, 7 unclear) and the remaining 10 had non-native OphA flow. RCBFMCA and CVRMCA each were significantly lower in non-native flow group (84.9 ± 18.9% vs. 69.8 ± 7.3%, P < 0.05; 36.4 ± 20.6% vs. 17.0 ± 15.0%, P < 0.05). Four patients in the non-native flow group and none in the native flow group were confirmed as high-risk (Sensitivity/Specificity, 1.00/0.65). Conclusion: The 6 min standard 4D Flow MRI assessment of OphA in patients with ICS can predict intracranial hemodynamic impairment.
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Affiliation(s)
- Tetsuro Sekine
- Department of Medical Radiology, University Hospital Zurich.,Department of Radiology, Nippon Medical School
| | - Ryo Takagi
- Department of Radiology, Nippon Medical School
| | - Yasuo Amano
- Department of Radiology, Nippon Medical School
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School
| | - Erika Orita
- Department of Radiology, Nippon Medical School
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Lawley CM, Broadhouse KM, Callaghan FM, Winlaw DS, Figtree GA, Grieve SM. 4D flow magnetic resonance imaging: role in pediatric congenital heart disease. Asian Cardiovasc Thorac Ann 2017; 26:28-37. [PMID: 28185475 DOI: 10.1177/0218492317694248] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Imaging-based evaluation of cardiac structure and function remains paramount in the diagnosis and monitoring of congenital heart disease in childhood. Accurate measurements of intra- and extracardiac hemodynamics are required to inform decision making, allowing planned timing of interventions prior to deterioration of cardiac function. Four-dimensional flow magnetic resonance imaging is a nonionizing noninvasive technology that allows accurate and reproducible delineation of blood flow at any anatomical location within the imaging volume of interest, and also permits derivation of physiological parameters such as kinetic energy and wall shear stress. Four-dimensional flow is the focus of a great deal of attention in adult medicine, however, the translation of this imaging technique into the pediatric population has been limited to date. A more broad-scaled application of 4-dimensional flow in pediatric congenital heart disease stands to increase our fundamental understanding of the cause and significance of abnormal blood flow patterns, may improve risk stratification, and inform the design and use of surgical and percutaneous correction techniques. This paper seeks to outline the application of 4-dimensional flow in the assessment and management of the pediatric population affected by congenital heart disease.
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Affiliation(s)
- Claire M Lawley
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia.,3 Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Kathryn M Broadhouse
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Fraser M Callaghan
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - David S Winlaw
- 4 Heart Centre for Children & University of Sydney, The Children's Hospital at Westmead, Sydney, Australia
| | - Gemma A Figtree
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia
| | - Stuart M Grieve
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia.,5 Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia
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39
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Khan MA, Liu J, Tarumi T, Lawley JS, Liu P, Zhu DC, Lu H, Zhang R. Measurement of cerebral blood flow using phase contrast magnetic resonance imaging and duplex ultrasonography. J Cereb Blood Flow Metab 2017; 37:541-549. [PMID: 26873888 PMCID: PMC5381449 DOI: 10.1177/0271678x16631149] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/25/2015] [Accepted: 12/28/2015] [Indexed: 11/16/2022]
Abstract
Phase contrast magnetic resonance imaging (PC-MRI) and color-coded duplex ultrasonography (CDUS) are commonly used for measuring cerebral blood flow in the internal carotid (ICA) and vertebral arteries. However, agreement between the two methods has been controversial. Recent development of high spatial and temporal resolution blood vessel wall edge-detection and wall-tracking methods with CDUS increased the accuracy and reliability of blood vessel diameter, hence cerebral blood flow measurement. The aim of this study was to compare the improved CDUS method with 3 T PC-MRI for cerebral blood flow measurements. We found that cerebral blood flow velocity measured in the ICA was lower using PC-MRI than CDUS (left ICA: PC-MRI, 18.0 ± 4.2 vs. CDUS, 25.6 ± 8.6 cm/s; right ICA: PC-MRI, 18.5 ± 4.8 vs. CDUS, 26.6 ± 6.7 cm/s, both p < 0.01). However, ICA diameters measured using PC-MRI were larger (left ICA: PC-MRI, 4.7 ± 0.50 vs. CDUS, 4.1 ± 0.46 mm; right ICA: PC-MRI, 4.5 ± 0.49 vs. CDUS, 4.0 ± 0.45 mm, both p < 0.01). Cerebral blood flow velocity measured in the left vertebral artery with PC-MRI was also lower than CDUS, but no differences in vertebral artery diameter were observed between the methods. Dynamic changes and/or intrinsic physiological fluctuations may have caused these differences in vessel diameter and velocity measurements between the methods. However, estimation of volumetric cerebral blood flow was similar and correlated between the methods despite the presence of large individual differences. These findings support the use of CDUS for cerebral blood flow measurements in the ICA and vertebral artery.
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Affiliation(s)
- Muhammad Ayaz Khan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas, Dallas, TX, USA
| | - Jie Liu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas, Dallas, TX, USA
| | - Takashi Tarumi
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas, Dallas, TX, USA
| | - Justin Stevan Lawley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas, Dallas, TX, USA
| | - Peiying Liu
- Advanced Imaging Research Center, University of Texas, Dallas, TX, USA
| | - David C Zhu
- Department of Radiology and Psychology, Michigan State University, East Lansing, MI, USA
| | - Hanzhang Lu
- Advanced Imaging Research Center, University of Texas, Dallas, TX, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
- Department of Internal Medicine, University of Texas, Dallas, TX, USA
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Ha H, Kim GB, Kweon J, Lee SJ, Kim YH, Lee DH, Yang DH, Kim N. Hemodynamic Measurement Using Four-Dimensional Phase-Contrast MRI: Quantification of Hemodynamic Parameters and Clinical Applications. Korean J Radiol 2016; 17:445-62. [PMID: 27390537 PMCID: PMC4936168 DOI: 10.3348/kjr.2016.17.4.445] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/22/2016] [Indexed: 11/21/2022] Open
Abstract
Recent improvements have been made to the use of time-resolved, three-dimensional phase-contrast (PC) magnetic resonance imaging (MRI), which is also named four-dimensional (4D) PC-MRI or 4D flow MRI, in the investigation of spatial and temporal variations in hemodynamic features in cardiovascular blood flow. The present article reviews the principle and analytical procedures of 4D PC-MRI. Various fluid dynamic biomarkers for possible clinical usage are also described, including wall shear stress, turbulent kinetic energy, and relative pressure. Lastly, this article provides an overview of the clinical applications of 4D PC-MRI in various cardiovascular regions.
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Affiliation(s)
- Hojin Ha
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang 37673, Korea
| | - Guk Bae Kim
- Asan Institute of Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jihoon Kweon
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Sang Joon Lee
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang 37673, Korea.; Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Namkug Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.; Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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41
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Rose MJ, Jarvis K, Chowdhary V, Barker AJ, Allen BD, Robinson JD, Markl M, Rigsby CK, Schnell S. Efficient method for volumetric assessment of peak blood flow velocity using 4D flow MRI. J Magn Reson Imaging 2016; 44:1673-1682. [PMID: 27192153 DOI: 10.1002/jmri.25305] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To test the feasibility and effectiveness of using maximum intensity plots (MIPs) based on 4D flow magnetic resonance imaging (MRI) velocity data to assess systolic peak velocities in a cohort of bicuspid aortic valve (BAV) patients. MATERIALS AND METHODS 4D flow MRI at 1.5T was performed on 51 BAV patients. MIPs were generated from the 4D flow MRI velocity data and used by two users to determine peak velocities in three regions of interest (ROIs): ascending aorta (AAo), aortic arch, and descending aorta. 4D flow MRI peak velocities in the AAo were compared to peak velocities recorded by 2D phase contrast MRI (2D PCMRI) in a subcohort of 36 patients and by Doppler echocardiography in a subcohort of 34 patients. 4D flow MRI peak velocities recorded by each observer were compared for all ROIs to test for interobserver variability. RESULTS 4D flow MRI recorded significantly higher velocities compared to 2D PCMRI (2.04 ± 0.71 m/s vs. 1.69 ± 0.79 m/s, 17.2% difference, P < 0.001) and similar velocities compared to Doppler echocardiography. There was excellent agreement between the observers, with a mean difference of 0.005 m/s and an intraclass correlation coefficient of 0.98. CONCLUSION 4D flow MRI velocity MIPs allow for efficient measurement of peak velocities in BAV patients with higher accuracy than 2D PCMRI and similar accuracy to Doppler echocardiography. J. Magn. Reson. Imaging 2016;44:1673-1682.
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Affiliation(s)
- Michael J Rose
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
| | - Varun Chowdhary
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua D Robinson
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Advanced flow MRI: emerging techniques and applications. Clin Radiol 2016; 71:779-95. [PMID: 26944696 DOI: 10.1016/j.crad.2016.01.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) techniques provide non-invasive and non-ionising methods for the highly accurate anatomical depiction of the heart and vessels throughout the cardiac cycle. In addition, the intrinsic sensitivity of MRI to motion offers the unique ability to acquire spatially registered blood flow simultaneously with the morphological data, within a single measurement. In clinical routine, flow MRI is typically accomplished using methods that resolve two spatial dimensions in individual planes and encode the time-resolved velocity in one principal direction, typically oriented perpendicular to the two-dimensional (2D) section. This review describes recently developed advanced MRI flow techniques, which allow for more comprehensive evaluation of blood flow characteristics, such as real-time flow imaging, 2D multiple-venc phase contrast MRI, four-dimensional (4D) flow MRI, quantification of complex haemodynamic properties, and highly accelerated flow imaging. Emerging techniques and novel applications are explored. In addition, applications of these new techniques for the improved evaluation of cardiovascular (aorta, pulmonary arteries, congenital heart disease, atrial fibrillation, coronary arteries) as well as cerebrovascular disease (intra-cranial arteries and veins) are presented.
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Qin Q, Shin T, Schär M, Guo H, Chen H, Qiao Y. Velocity-selective magnetization-prepared non-contrast-enhanced cerebral MR angiography at 3 Tesla: Improved immunity to B0/B1 inhomogeneity. Magn Reson Med 2016; 75:1232-41. [PMID: 25940706 PMCID: PMC4630207 DOI: 10.1002/mrm.25764] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE To develop a Fourier-transform based velocity-selective (VS) pulse train that offers improved robustness to B0/B1 inhomogeneity for non-contrast-enhanced cerebral MR angiography (MRA) at 3 Tesla (T). METHODS VS pulse train I and II with different saturation bands are proposed to incorporate paired and phase cycled refocusing pulses. Their sensitivity to B0/B1 inhomogeneity was estimated through simulation and compared with a single refocused VS pulse train. The implementation was compared to standard time of flight (TOF) among eight healthy subjects. RESULTS In contrast to single refocused VS pulse train, the simulated VS profiles from proposed pulse trains indicate much improved immunity to field inhomogeneity in the brain at 3T. Successive application of two identical VS pulse trains yields a better suppression of static tissue at the cost of 20 ∼ 30% signal loss within large vessels. Average relative contrast ratios of major cerebral arterial segments applying both pulse train I and II with two preparations are 0.81 ± 0.06 and 0.81 ± 0.05, respectively, significantly higher than 0.67 ± 0.07 of TOF-MRA. VS MRA, in particular, the pulse train II with the narrower saturation band, depicts more small vessels with slower flow. CONCLUSION VS magnetization-prepared cerebral MRA was demonstrated among normal subjects on a 3T scanner.
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Affiliation(s)
- Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Taehoon Shin
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA
| | - Michael Schär
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hua Guo
- Center for Biomedical imaging Research, Biomedical Engineering, Tsinghua University, Beijing, China
| | - Hanwei Chen
- Department of Radiology, Panyu District Central Hospital, Guangzhou, China
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Normal ranges and test-retest reproducibility of flow and velocity parameters in intracranial arteries measured with phase-contrast magnetic resonance imaging. Neuroradiology 2016; 58:521-31. [PMID: 26882908 DOI: 10.1007/s00234-016-1661-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of the present study was to investigate normal ranges and test-retest reproducibility of phase-contrast MRI (PC-MRI)-measured flow and velocity parameters in intracranial arteries. METHODS Highest flow (HF), lowest flow (LF), peak systolic velocity (PSV), and end diastolic velocity (EDV) were measured at two dates in the anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries of 30 healthy volunteers using two-dimensional PC-MRI at 3 T. Least detectable difference (LDD) was calculated. RESULTS In the left ACA, HF was (mean (range, LDD)) 126 ml/min (36-312, 59 %), LF 61 ml/min (0-156, 101 %), PSV 64 cm/s (32-141, 67 %), and EDV 35 cm/s (18-55, 42 %); in the right ACA, HF was 154 ml/min (42-246, 49 %), LF 77 ml/min (0-156, 131 %), PSV 75 cm/s (26-161, 82 %), and EDV 39 cm/s (7-59, 67 %). In the left MCA, HF was 235 ml/min (126-372, 35 %), LF 116 ml/min (42-186, 48 %), PSV 90 cm/s (55-183, 39 %), and EDV 46 cm/s (20-66, 28 %); in the right MCA, HF was 238 ml/min (162-342, 44 %), LF 120 ml/min (72-216, 48 %), PSV 88 cm/s (55-141, 35 %), and EDV 45 cm/s (26-67, 23 %). In the left PCA, HF was 108 ml/min (42-168, 54 %), LF 53 ml/min (18-108, 64 %), PSV 50 cm/s (24-77, 63 %), and EDV 28 cm/s (14-40, 45 %); in the right PCA, HF was 98 ml/min (30-162, 49 %), LF 49 ml/min (12-84, 55 %), PSV 47 cm/s (27-88, 59 %), and EDV 27 cm/s (16-41, 45 %). CONCLUSION PC-MRI-measured flow and velocity parameters in the main intracranial arteries have large normal ranges. Reproducibility is highest in MCA.
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Stankovic Z. Four-dimensional flow magnetic resonance imaging in cirrhosis. World J Gastroenterol 2016; 22:89-102. [PMID: 26755862 PMCID: PMC4698511 DOI: 10.3748/wjg.v22.i1.89] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/08/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in the 1970’s, magnetic resonance imaging (MRI) has become a standard imaging modality. With its broad and standardized application, it is firmly established in the clinical routine and an essential element in cardiovascular and abdominal imaging. In addition to sonography and computer tomography, MRI is a valuable tool for diagnosing cardiovascular and abdominal diseases, for determining disease severity, and for assessing therapeutic success. MRI techniques have improved over the last few decades, revealing not just morphologic information, but functional information about perfusion, diffusion and hemodynamics as well. Four-dimensional (4D) flow MRI, a time-resolved phase contrast-MRI with three-dimensional (3D) anatomic coverage and velocity encoding along all three flow directions has been used to comprehensively assess complex cardiovascular hemodynamics in multiple regions of the body. The technique enables visualization of 3D blood flow patterns and retrospective quantification of blood flow parameters in a region of interest. Over the last few years, 4D flow MRI has been increasingly performed in the abdominal region. By applying different acceleration techniques, taking 4D flow MRI measurements has dropped to a reasonable scanning time of 8 to 12 min. These new developments have encouraged a growing number of patient studies in the literature validating the technique’s potential for enhanced evaluation of blood flow parameters within the liver’s complex vascular system. The purpose of this review article is to broaden our understanding of 4D flow MRI for the assessment of liver hemodynamics by providing insights into acquisition, data analysis, visualization and quantification. Furthermore, in this article we highlight its development, focussing on the clinical application of the technique.
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46
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Wu C, Honarmand AR, Schnell S, Kuhn R, Schoeneman SE, Ansari SA, Carr J, Markl M, Shaibani A. Age-Related Changes of Normal Cerebral and Cardiac Blood Flow in Children and Adults Aged 7 Months to 61 Years. J Am Heart Assoc 2016; 5:e002657. [PMID: 26727967 PMCID: PMC4859381 DOI: 10.1161/jaha.115.002657] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/22/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral and cardiac blood flow are important to the pathophysiology and development of cerebro- and cardiovascular diseases. The purpose of this study was to investigate the age dependence of normal cerebral and cardiac hemodynamics in children and adults over a broad range of ages. METHODS AND RESULTS Overall, 52 children (aged 0.6-17.2 years) and 30 adults (aged 19.2-60.7 years) without cerebro- and cardiovascular diseases were included in this study. Intracranial 4-dimensional flow and cardiac 2-dimensional phase-contrast magnetic resonance imaging were performed for all participants to measure flow parameters in the major intracranial vessels and aorta. Total cerebral blood flow (TCBF), cardiac and cerebral indexes, brain volume, and global cerebral perfusion (TCBF/brain volume) were evaluated. Flow analysis revealed that TCBF increased significantly from age 7 months to 6 years (P<0.001) and declined thereafter (P<0.001). Both cardiac and cerebral indices declined with age (P<0.001). The ratio of TCBF to ascending aortic flow declined rapidly until age 18 years (P<0.001) and remained relatively stable thereafter. Age-related changes of cerebral vascular peak velocities exhibited a trend similar to TCBF. By comparison, aortic peak velocities maintained relatively high levels in children and declined with age in adults (P<0.001). TCBF significantly correlated with brain volume in adults (P=0.005) and in 2 pediatric subgroups, aged <7 years (P<0.001) and 7 to 18 years (P=0.039). CONCLUSIONS Cerebral and cardiac flow parameters are highly associated with age. The findings collectively highlight the importance of age-matched control data for the characterization of intracranial and cardiac hemodynamics.
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Affiliation(s)
- Can Wu
- Department of Biomedical EngineeringMcCormick School of EngineeringNorthwestern UniversityEvanstonIL
- Department of RadiologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Amir R. Honarmand
- Department of RadiologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Susanne Schnell
- Department of RadiologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Ryan Kuhn
- Department of Medical ImagingAnn & Robert H. Lurie Children's Hospital of ChicagoIL
| | | | - Sameer A. Ansari
- Department of RadiologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
- Department of Neurological SurgeryFeinberg School of MedicineNorthwestern UniversityChicagoIL
- Department of NeurologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - James Carr
- Department of RadiologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Michael Markl
- Department of Biomedical EngineeringMcCormick School of EngineeringNorthwestern UniversityEvanstonIL
- Department of RadiologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Ali Shaibani
- Department of RadiologyFeinberg School of MedicineNorthwestern UniversityChicagoIL
- Department of Neurological SurgeryFeinberg School of MedicineNorthwestern UniversityChicagoIL
- Department of Medical ImagingAnn & Robert H. Lurie Children's Hospital of ChicagoIL
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Sekine T, Takagi R, Amano Y, Murai Y, Orita E, Matsumura Y, Kumita SI. 4D flow MRI assessment of extracranial-intracranial bypass: qualitative and quantitative evaluation of the hemodynamics. Neuroradiology 2015; 58:237-44. [DOI: 10.1007/s00234-015-1626-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/25/2015] [Indexed: 02/02/2023]
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Eker OF, Boudjeltia KZ, Jerez RAC, Le Bars E, Sanchez M, Bonafé A, Costalat V, Courbebaisse G. MR derived volumetric flow rate waveforms of internal carotid artery in patients treated for unruptured intracranial aneurysms by flow diversion technique. J Cereb Blood Flow Metab 2015; 35:2070-9. [PMID: 26264871 PMCID: PMC4671130 DOI: 10.1038/jcbfm.2015.176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/27/2015] [Accepted: 06/22/2015] [Indexed: 11/09/2022]
Abstract
Little is known about the hemodynamic disturbances induced by the cerebral aneurysms in the parent artery and the effect of flow diverter stents (FDS) on these latter. A better understanding of the aneurysm-parent vessel complex relationship may aid our understanding of this disease and to optimize its treatment. The ability of volumetric flow rate (VFR) waveform to reflect the arterial compliance modifications is well known. By analyzing the VFR waveform and the pulsatility in the parent vessel, this study aimed to test the hypotheses that (1) intracranial aneurysms might disrupt the blood flow of the parent vessel and (2) the treatment by FDS might have measurable corrective effect on these changes. Ten patients followed for unruptured intracranial aneurysms treated by FDS and ten healthy volunteers as control group were included in this study. Two-dimensional quantitative phase-contrast magnetic resonance imaging (MRI) was performed on each patient on the ICA artery upstream and downstream to the aneurysm, and on each volunteer at similar locations. The aneurysms altered significantly the parent vessel pulsatility and this effect was correlated to their volume. The aneurysms treatment by FDS allowed for the restoration of a normally modulated flow and pulsatility correction in the parent vessel.
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Affiliation(s)
- Omer F Eker
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France.,CREATIS Laboratory-INSA Lyon, Villeurbanne, France.,Laboratory of Experimental Medicine (ULB 222 Unit), CHU Charleroi, Hôpital Vésale, Montigny-le-Tilleul, Belgium
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medicine (ULB 222 Unit), CHU Charleroi, Hôpital Vésale, Montigny-le-Tilleul, Belgium
| | | | - Emmanuelle Le Bars
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
| | - Mathieu Sanchez
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
| | - Alain Bonafé
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
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Dyverfeldt P, Bissell M, Barker AJ, Bolger AF, Carlhäll CJ, Ebbers T, Francios CJ, Frydrychowicz A, Geiger J, Giese D, Hope MD, Kilner PJ, Kozerke S, Myerson S, Neubauer S, Wieben O, Markl M. 4D flow cardiovascular magnetic resonance consensus statement. J Cardiovasc Magn Reson 2015; 17:72. [PMID: 26257141 PMCID: PMC4530492 DOI: 10.1186/s12968-015-0174-5] [Citation(s) in RCA: 584] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/17/2015] [Indexed: 02/07/2023] Open
Abstract
Pulsatile blood flow through the cavities of the heart and great vessels is time-varying and multidirectional. Access to all regions, phases and directions of cardiovascular flows has formerly been limited. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has enabled more comprehensive access to such flows, with typical spatial resolution of 1.5×1.5×1.5 - 3×3×3 mm(3), typical temporal resolution of 30-40 ms, and acquisition times in the order of 5 to 25 min. This consensus paper is the work of physicists, physicians and biomedical engineers, active in the development and implementation of 4D Flow CMR, who have repeatedly met to share experience and ideas. The paper aims to assist understanding of acquisition and analysis methods, and their potential clinical applications with a focus on the heart and greater vessels. We describe that 4D Flow CMR can be clinically advantageous because placement of a single acquisition volume is straightforward and enables flow through any plane across it to be calculated retrospectively and with good accuracy. We also specify research and development goals that have yet to be satisfactorily achieved. Derived flow parameters, generally needing further development or validation for clinical use, include measurements of wall shear stress, pressure difference, turbulent kinetic energy, and intracardiac flow components. The dependence of measurement accuracy on acquisition parameters is considered, as are the uses of different visualization strategies for appropriate representation of time-varying multidirectional flow fields. Finally, we offer suggestions for more consistent, user-friendly implementation of 4D Flow CMR acquisition and data handling with a view to multicenter studies and more widespread adoption of the approach in routine clinical investigations.
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Affiliation(s)
- Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
| | - Malenka Bissell
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, USA.
| | - Ann F Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
- Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
| | | | - Alex Frydrychowicz
- Klinik für Radiologie und Nuklearmedizin, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Julia Geiger
- Department of Radiology, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Daniel Giese
- Department of Radiology, University Hospital of Cologne, Cologne, Germany.
| | - Michael D Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, United States.
| | - Philip J Kilner
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, UK.
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA.
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA.
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, USA.
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA.
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Blood flow distribution in cerebral arteries. J Cereb Blood Flow Metab 2015; 35:648-54. [PMID: 25564234 PMCID: PMC4420884 DOI: 10.1038/jcbfm.2014.241] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/11/2014] [Accepted: 12/03/2014] [Indexed: 01/25/2023]
Abstract
High-resolution phase-contrast magnetic resonance imaging can now assess flow in proximal and distal cerebral arteries. The aim of this study was to describe how total cerebral blood flow (tCBF) is distributed into the vascular tree with regard to age, sex and anatomic variations. Forty-nine healthy young (mean 25 years) and 45 elderly (mean 71 years) individuals were included. Blood flow rate (BFR) in 21 intra- and extracerebral arteries was measured. Total cerebral blood flow was defined as BFR in the internal carotid plus vertebral arteries and mean cerebral perfusion as tCBF/brain volume. Carotid/vertebral distribution was 72%/28% and was not related to age, sex, or brain volume. Total cerebral blood flow (717 ± 123 mL/min) was distributed to each side as follows: middle cerebral artery (MCA), 21%; distal MCA, 6%; anterior cerebral artery (ACA), 12%, distal ACA, 4%; ophthalmic artery, 2%; posterior cerebral artery (PCA), 8%; and 20% to basilar artery. Deviating distributions were observed in subjects with 'fetal' PCA. Blood flow rate in cerebral arteries decreased with increasing age (P<0.05) but not in extracerebral arteries. Mean cerebral perfusion was higher in women (women: 61 ± 8; men: 55 ± 6 mL/min/100 mL, P<0.001). The study describes a new method to outline the flow profile of the cerebral vascular tree, including reference values, and should be used for grading the collateral flow system.
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