Voxel-by-voxel 4D flow MRI-based assessment of regional reverse flow in the aorta

Xin Shen, Susanne Schnell, Alex J. Barker, Kenichiro Suwa, Lingzi Tashakkor, Kelly Jarvis, James C. Carr, Jeremy D. Collins, Shyam Prabhakaran, Michael Markl*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Complex and reverse flow in the aorta has been implicated in aneurysm development and stroke via retrograde embolization. Purpose: To evaluate global and regional differences between standard 2D plane-based and volumetric voxel-based quantification of regional forward/reverse flow, and reverse flow fraction (RFF) in the aorta. Study Type: Retrospective. Subjects: In all, 35 subjects: 10 healthy controls (age: 57 ± 7 years, nine male), nine patients without aortic valve regurgitation (AR) (age: 63 ± 10 years, seven male), six patients with mild AR (age: 66 ± 6 years, five male), and 10 with moderate or severe AR (age: 60 ± 16 years, eight male). Field Strength/Sequence: 4D flow MRI (3T and 1.5T) was employed to acquire 3D blood flow velocities with entire thoracic aorta in all subjects. Assessment: Data analysis included standard 2D plane-based quantification of forward/reverse flow, and RFF-plane. In addition, a new semiautomatic workflow based on 3D segmentation and extraction of an aorta centerline was developed for voxel-by-voxel visualization (forward/reverse flow and RFF-voxel maps) and quantification of regional voxel-by-voxel forward/reverse flow in the entire thoracic aorta. Statistical Tests: Kruskal–Wallis tests were performed to test for differences between groups. A two-sample t-test or Wilcoxon rank sum test was used to compare voxel-based and plane-based results. Results: Semiautomatic plane-based analysis showed excellent agreement with standard manual plane-based analysis for net flow and RFF-plane (RFF-plane: y = 0.99x-0.0, net flow: y = 1.00x-0.21, R > 0.99, P < 0.0001). Voxel-by-voxel maps demonstrated marked regional flow reversal in the ascending aorta in all patients and RFF-voxel was significantly increased (P < 0.001) compared to RFF-plane for all four groups, with the most pronounced differences for mild AR (18.0 ± 15.2% vs. 4.7 ± 5.4%). Voxel-based flow and RFF-voxel along the aorta showed areas with marked regional flow reversal (eg, vortex flow) compared to plane-based analysis. Data Conclusion: Voxel-based analysis demonstrated regional flow reversal that was not detected by plane-based analysis. Level of Evidence: 3. Technical Efficacy: Stage 1. J. Magn. Reson. Imaging 2018;47:1276–1286.

Original languageEnglish (US)
Pages (from-to)1276-1286
Number of pages11
JournalJournal of Magnetic Resonance Imaging
Issue number5
StatePublished - May 2018


  • 4D flow MRI
  • flow
  • flow reversal
  • quantification

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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