4D Flow 2D Phase Contrast MRI in Populations With Bi- and Tricuspid Aortic Valves

Overview

Journal In Vivo

Specialty Oncology

Date 2023 Jan 2

PMID 36593031

Authors

Sofia Hautanen

Teemu Kiljander

Tarmo Korpela

Petri Saari

Jorma Kokkonen

Pirjo Mustonen

Saara Sillanmaki

Elias Yla-Herttuala

Minna Husso

Marja Hedman

Petteri Kauhanen

Affiliations

Soon will be listed here.

Abstract

Aim: To compare 4D flow magnetic resonance imaging (MRI) and 2D phase contrast (PC) MRI when evaluating bicuspid (BAV) and tricuspid (TAV) aortic valves.

Materials And Methods: A total of 83 subjects (35 BAV, 48 TAV) were explored with 4D flow and 2D PC MRI. Systolic peak velocity, peak flow and regurgitation fraction were analysed at two pre-defined aortic levels (aortic root, mid-tubular). Furthermore, the two methods of 4D flow analysis (Heart and Artery) were compared.

Results: Correlation between the 2D PC MRI and 4D flow MRI derived parameters ranged from moderate (R=0.58) to high (R=0.90). 4D flow MRI yielded significantly higher peak velocities in the tubular aorta in both groups. Regarding the aortic root, peak velocities were significantly higher in the TAV group with 4D flow MRI, but in the BAV group 4D flow MRI yielded non-significantly lower values. Findings on peak flow differences between the two modalities followed the same pattern as the differences in peak velocities. 4D flow MRI derived regurgitation fraction values were lower in both locations in both groups. Interobserver agreement for different 4D flow MRI acquired parameters varied from poor (ICC=0.07) to excellent (ICC=1.0) in the aortic root, and it was excellent in the tubular aorta (ICC=0.8-1.0).

Conclusion: 4D flow MRI seems to be accurate in comparison to 2D PC MRI in normal aortic valves and in BAV with mild to moderate stenosis. However, the varying interobserver reproducibility and impaired accuracy at higher flow velocities should be taken into account in clinical practice when using the 4D flow method.

Citing Articles

Performance of respiratory gated 4D flow MRI with adaptive k-space reordering in healthy controls and aortic dissection: reproducibility and agreement with 2D phase contrast MRI.

Wang Q, Guo X, Hornsey E, McKenna L, Churilov L, Brooks M Int J Cardiovasc Imaging. 2024; 41(2):211-223.

PMID: 39674984 DOI: 10.1007/s10554-024-03298-2.

Evaluating the Diagnostic Potential of Four-Dimensional Flow Magnetic Resonance Imaging in Aortic Stenosis Diagnosis: A Systematic Review and Meta-Analysis.

Chandrasekar S, Kolli M, George A, Kodali D, Nagaraja Shivamoggi H, Girivasan S Cureus. 2024; 16(11):e73339.

PMID: 39524162 PMC: 11550489. DOI: 10.7759/cureus.73339.

Simulating Subject-Specific Aortic Hemodynamic Effects of Valvular Lesions in Rheumatic Heart Disease.

Cebull H, Aremu O, Kulkarni R, Zhang S, Samuels P, Jermy S J Biomech Eng. 2023; 145(11).

PMID: 37470483 PMC: 10405283. DOI: 10.1115/1.4063000.

References

Kauhanen S, Hedman M, Kariniemi E, Jaakkola P, Vanninen R, Saari P . Aortic dilatation associates with flow displacement and increased circumferential wall shear stress in patients without aortic stenosis: A prospective clinical study. J Magn Reson Imaging. 2019; 50(1):136-145. DOI: 10.1002/jmri.26655. View

Markl M, Frydrychowicz A, Kozerke S, Hope M, Wieben O . 4D flow MRI. J Magn Reson Imaging. 2012; 36(5):1015-36. DOI: 10.1002/jmri.23632. View

Yuan S, Jing H, Lavee J . The bicuspid aortic valve and its relation to aortic dilation. Clinics (Sao Paulo). 2010; 65(5):497-505. PMC: 2882544. DOI: 10.1590/S1807-59322010000500007. View

Baumgartner H, Falk V, Bax J, De Bonis M, Hamm C, Holm P . 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36):2739-2791. DOI: 10.1093/eurheartj/ehx391. View

Liu T, Xie M, Lv Q, Li Y, Fang L, Zhang L . Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment. Front Physiol. 2019; 9:1921. PMC: 6363677. DOI: 10.3389/fphys.2018.01921. View

Halva R, Vaara S, Peltonen J, Kaasalainen T, Holmstrom M, Lommi J . Peak flow measurements in patients with severe aortic stenosis: a prospective comparative study between cardiovascular magnetic resonance 2D and 4D flow and transthoracic echocardiography. J Cardiovasc Magn Reson. 2021; 23(1):132. PMC: 8591846. DOI: 10.1186/s12968-021-00825-1. View

Jacobs K, Chan F, Cheng J, Vasanawala S, Maskatia S . 4D flow vs. 2D cardiac MRI for the evaluation of pulmonary regurgitation and ventricular volume in repaired tetralogy of Fallot: a retrospective case control study. Int J Cardiovasc Imaging. 2020; 36(4):657-669. PMC: 8018898. DOI: 10.1007/s10554-019-01751-1. View

Bissell M, Hess A, Biasiolli L, Glaze S, Loudon M, Pitcher A . Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging. 2013; 6(4):499-507. PMC: 3859916. DOI: 10.1161/CIRCIMAGING.113.000528. View

Mahadevia R, Barker A, Schnell S, Entezari P, Kansal P, Fedak P . Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy. Circulation. 2013; 129(6):673-82. PMC: 3946057. DOI: 10.1161/CIRCULATIONAHA.113.003026. View

10.

van Ooij P, Markl M, Collins J, Carr J, Rigsby C, Bonow R . Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4-Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects. J Am Heart Assoc. 2017; 6(9). PMC: 5634265. DOI: 10.1161/JAHA.117.005959. View

11.

Hope M, Sigovan M, Wrenn S, Saloner D, Dyverfeldt P . MRI hemodynamic markers of progressive bicuspid aortic valve-related aortic disease. J Magn Reson Imaging. 2014; 40(1):140-5. PMC: 4010553. DOI: 10.1002/jmri.24362. View

12.

Siu S, Silversides C . Bicuspid aortic valve disease. J Am Coll Cardiol. 2010; 55(25):2789-800. DOI: 10.1016/j.jacc.2009.12.068. View

13.

Lotz J, Meier C, Leppert A, Galanski M . Cardiovascular flow measurement with phase-contrast MR imaging: basic facts and implementation. Radiographics. 2002; 22(3):651-71. DOI: 10.1148/radiographics.22.3.g02ma11651. View

14.

Tzemos N, Therrien J, Yip J, Thanassoulis G, Tremblay S, Jamorski M . Outcomes in adults with bicuspid aortic valves. JAMA. 2008; 300(11):1317-25. DOI: 10.1001/jama.300.11.1317. View

15.

Koo T, Li M . A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016; 15(2):155-63. PMC: 4913118. DOI: 10.1016/j.jcm.2016.02.012. View

16.

Dyverfeldt P, Bissell M, Barker A, Bolger A, Carlhall C, Ebbers T . 4D flow cardiovascular magnetic resonance consensus statement. J Cardiovasc Magn Reson. 2015; 17:72. PMC: 4530492. DOI: 10.1186/s12968-015-0174-5. View

17.

Michelena H, Khanna A, Mahoney D, Margaryan E, Topilsky Y, Suri R . Incidence of aortic complications in patients with bicuspid aortic valves. JAMA. 2011; 306(10):1104-12. DOI: 10.1001/jama.2011.1286. View