In Vivo Assessment of Wall Shear Stress in the Atherosclerotic Aorta Using Flow-sensitive 4D MRI

Our purpose was to correlate atherogenic low wall shear stress (WSS) and high oscillatory shear index (OSI) with the localization of aortic plaques. Flow-sensitive four-dimensional MRI was used to acquire three-dimensional blood flow in the aorta of 62 patients with proven aortic atherosclerosis and 31 healthy volunteers. Multiplanar data analysis of WSS magnitude and OSI in 12 wall segments was performed in analysis planes distributed along the aorta. Disturbed WSS and OSI were defined as areas exposed to low WSS magnitude and high OSI beyond individual 15% thresholds. Planewise analysis revealed a good correlation (r = 0.85) of individual low WSS magnitude but not of high OSI with plaque distribution. Although plaques occurred only rarely in the ascending aorta, the incidence of low WSS magnitude and high OSI was similar to findings in other aortic segments where plaques occurred more frequently. Case-by-case comparisons of plaque location and critical wall parameters revealed a shift of atherogenic WSS magnitude (78% of all cases) and OSI (91%) to wall segments adjacent to the atheroma. Our results indicate that the predictive value of WSS for plaque existence depends on the aortic segment and that locations of critical wall parameters move to neighboring segments of regions affected by atherosclerosis.