Evaluation of aortic stenosis severity using 4D flow jet shear layer detection for the measurement of valve effective orifice area

Julio Garcia; Michael Markl; Susanne Schnell; Bradley Allen; Pegah Entezari; Riti Mahadevia; S Chris Malaisrie; Philippe Pibarot; James Carr; Alex J Barker

doi:10.1016/j.mri.2014.04.017

Evaluation of aortic stenosis severity using 4D flow jet shear layer detection for the measurement of valve effective orifice area

Julio Garcia^*, Michael Markl, Susanne Schnell, Bradley Allen, Pegah Entezari, Riti Mahadevia, S Chris Malaisrie, Philippe Pibarot, James Carr, Alex J Barker

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

26 Scopus citations

Abstract

Aims: The objective of this study was to evaluate the potential of 4D flow MRI to assess valve effective orifice area (EOA) in patients with aortic stenosis as determined by the jet shear layer detection (JSLD) method. Methods and Results: An in-vitro stenosis phantom was used for validation and in-vivo imaging was performed in 10 healthy controls and 40 patients with aortic stenosis. EOA was calculated by the JSLD method using standard 2D phase contrast MRI (PC-MRI) and 4D flow MRI measurements (EOA_JSLD-2D and EOA_JSLD-4D, respectively). As a reference standard, the continuity equation was used to calculate EOA (EOA_CE) with the 2D PC-MRI velocity field and compared to the EOA_JSLD measurements. The in-vitro results exhibited excellent agreement between flow theory (EOA=0.78cm²) and experimental measurement (EOA_JSLD-4D=0.78±0.01cm²) for peak velocities ranging from 0.9 to 3.7m/s. In-vivo results showed good correlation and agreement between EOA_JSLD-2D and EOA_CE (r=0.91, p<0.001; bias: -0.01±0.38cm²; agreement limits: 0.75 to -0.77cm²), and between EOA_JSLD-4D and EOA_CE (r=0.95, p<0.001; bias: -0.09±0.26cm²; limits: 0.43 to -0.62cm²). Conclusion: This study demonstrates the feasibility of measuring EOA_JSLD using 4D flow MRI. The technique allows for optimization of the EOA measurement position by visualizing the 3D vena contracta, and avoids potential sources of EOA_CE measurement variability.

Original language	English (US)
Pages (from-to)	891-898
Number of pages	8
Journal	Magnetic Resonance Imaging
Volume	32
Issue number	7
DOIs	https://doi.org/10.1016/j.mri.2014.04.017
State	Published - Sep 2014

Funding

This work was supported by NIH R01HL115828, AHA 13SDG14360004 grants and NUCATS Dixon Award. J. Garcia was supported by CONACyT (203355), AHA 14POST18350019 and ACCEM Laval University doctoral fellow award. Dr. Schnell is supported by the SIR Pilot Study grant and a DFG scholarship (SCHN 1170/1-1). Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases, Canadian Institutes of Health Research, Ottawa, Ontario, Canada.

Keywords

4D flow MRI
Aortic stenosis
Effective orifice area
Jet shear layer

ASJC Scopus subject areas

Biophysics
Biomedical Engineering
Radiology Nuclear Medicine and imaging

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10.1016/j.mri.2014.04.017

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@article{afcfdaf8bfbb430c968041d3a2aeed3d,

title = "Evaluation of aortic stenosis severity using 4D flow jet shear layer detection for the measurement of valve effective orifice area",

abstract = "Aims: The objective of this study was to evaluate the potential of 4D flow MRI to assess valve effective orifice area (EOA) in patients with aortic stenosis as determined by the jet shear layer detection (JSLD) method. Methods and Results: An in-vitro stenosis phantom was used for validation and in-vivo imaging was performed in 10 healthy controls and 40 patients with aortic stenosis. EOA was calculated by the JSLD method using standard 2D phase contrast MRI (PC-MRI) and 4D flow MRI measurements (EOAJSLD-2D and EOAJSLD-4D, respectively). As a reference standard, the continuity equation was used to calculate EOA (EOACE) with the 2D PC-MRI velocity field and compared to the EOAJSLD measurements. The in-vitro results exhibited excellent agreement between flow theory (EOA=0.78cm2) and experimental measurement (EOAJSLD-4D=0.78±0.01cm2) for peak velocities ranging from 0.9 to 3.7m/s. In-vivo results showed good correlation and agreement between EOAJSLD-2D and EOACE (r=0.91, p<0.001; bias: -0.01±0.38cm2; agreement limits: 0.75 to -0.77cm2), and between EOAJSLD-4D and EOACE (r=0.95, p<0.001; bias: -0.09±0.26cm2; limits: 0.43 to -0.62cm2). Conclusion: This study demonstrates the feasibility of measuring EOAJSLD using 4D flow MRI. The technique allows for optimization of the EOA measurement position by visualizing the 3D vena contracta, and avoids potential sources of EOACE measurement variability.",

keywords = "4D flow MRI, Aortic stenosis, Effective orifice area, Jet shear layer",

author = "Julio Garcia and Michael Markl and Susanne Schnell and Bradley Allen and Pegah Entezari and Riti Mahadevia and Malaisrie, {S Chris} and Philippe Pibarot and James Carr and Barker, {Alex J}",

note = "Funding Information: This work was supported by NIH R01HL115828, AHA 13SDG14360004 grants and NUCATS Dixon Award. J. Garcia was supported by CONACyT (203355), AHA 14POST18350019 and ACCEM Laval University doctoral fellow award. Dr. Schnell is supported by the SIR Pilot Study grant and a DFG scholarship (SCHN 1170/1-1). Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases, Canadian Institutes of Health Research, Ottawa, Ontario, Canada.",

year = "2014",

month = sep,

doi = "10.1016/j.mri.2014.04.017",

language = "English (US)",

volume = "32",

pages = "891--898",

journal = "Magnetic Resonance Imaging",

issn = "0730-725X",

publisher = "Elsevier Inc.",

number = "7",

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TY - JOUR

T1 - Evaluation of aortic stenosis severity using 4D flow jet shear layer detection for the measurement of valve effective orifice area

AU - Garcia, Julio

AU - Markl, Michael

AU - Schnell, Susanne

AU - Allen, Bradley

AU - Entezari, Pegah

AU - Mahadevia, Riti

AU - Malaisrie, S Chris

AU - Pibarot, Philippe

AU - Carr, James

AU - Barker, Alex J

N1 - Funding Information: This work was supported by NIH R01HL115828, AHA 13SDG14360004 grants and NUCATS Dixon Award. J. Garcia was supported by CONACyT (203355), AHA 14POST18350019 and ACCEM Laval University doctoral fellow award. Dr. Schnell is supported by the SIR Pilot Study grant and a DFG scholarship (SCHN 1170/1-1). Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases, Canadian Institutes of Health Research, Ottawa, Ontario, Canada.

PY - 2014/9

Y1 - 2014/9

N2 - Aims: The objective of this study was to evaluate the potential of 4D flow MRI to assess valve effective orifice area (EOA) in patients with aortic stenosis as determined by the jet shear layer detection (JSLD) method. Methods and Results: An in-vitro stenosis phantom was used for validation and in-vivo imaging was performed in 10 healthy controls and 40 patients with aortic stenosis. EOA was calculated by the JSLD method using standard 2D phase contrast MRI (PC-MRI) and 4D flow MRI measurements (EOAJSLD-2D and EOAJSLD-4D, respectively). As a reference standard, the continuity equation was used to calculate EOA (EOACE) with the 2D PC-MRI velocity field and compared to the EOAJSLD measurements. The in-vitro results exhibited excellent agreement between flow theory (EOA=0.78cm2) and experimental measurement (EOAJSLD-4D=0.78±0.01cm2) for peak velocities ranging from 0.9 to 3.7m/s. In-vivo results showed good correlation and agreement between EOAJSLD-2D and EOACE (r=0.91, p<0.001; bias: -0.01±0.38cm2; agreement limits: 0.75 to -0.77cm2), and between EOAJSLD-4D and EOACE (r=0.95, p<0.001; bias: -0.09±0.26cm2; limits: 0.43 to -0.62cm2). Conclusion: This study demonstrates the feasibility of measuring EOAJSLD using 4D flow MRI. The technique allows for optimization of the EOA measurement position by visualizing the 3D vena contracta, and avoids potential sources of EOACE measurement variability.

AB - Aims: The objective of this study was to evaluate the potential of 4D flow MRI to assess valve effective orifice area (EOA) in patients with aortic stenosis as determined by the jet shear layer detection (JSLD) method. Methods and Results: An in-vitro stenosis phantom was used for validation and in-vivo imaging was performed in 10 healthy controls and 40 patients with aortic stenosis. EOA was calculated by the JSLD method using standard 2D phase contrast MRI (PC-MRI) and 4D flow MRI measurements (EOAJSLD-2D and EOAJSLD-4D, respectively). As a reference standard, the continuity equation was used to calculate EOA (EOACE) with the 2D PC-MRI velocity field and compared to the EOAJSLD measurements. The in-vitro results exhibited excellent agreement between flow theory (EOA=0.78cm2) and experimental measurement (EOAJSLD-4D=0.78±0.01cm2) for peak velocities ranging from 0.9 to 3.7m/s. In-vivo results showed good correlation and agreement between EOAJSLD-2D and EOACE (r=0.91, p<0.001; bias: -0.01±0.38cm2; agreement limits: 0.75 to -0.77cm2), and between EOAJSLD-4D and EOACE (r=0.95, p<0.001; bias: -0.09±0.26cm2; limits: 0.43 to -0.62cm2). Conclusion: This study demonstrates the feasibility of measuring EOAJSLD using 4D flow MRI. The technique allows for optimization of the EOA measurement position by visualizing the 3D vena contracta, and avoids potential sources of EOACE measurement variability.

KW - 4D flow MRI

KW - Aortic stenosis

KW - Effective orifice area

KW - Jet shear layer

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Evaluation of aortic stenosis severity using 4D flow jet shear layer detection for the measurement of valve effective orifice area

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