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

doi:10.1002/jmri.25862

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 journal › Article › peer-review

9 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	1276-1286
Number of pages	11
Journal	Journal of Magnetic Resonance Imaging
Volume	47
Issue number	5
DOIs	https://doi.org/10.1002/jmri.25862
State	Published - May 2018

Keywords

4D flow MRI
flow
flow reversal
quantification

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1002/jmri.25862

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@article{64d322a5b2574c8dbb6a4b2ef0da1120,

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

abstract = "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.",

keywords = "4D flow MRI, flow, flow reversal, quantification",

author = "Xin Shen and Susanne Schnell and Barker, {Alex J.} and Kenichiro Suwa and Lingzi Tashakkor and Kelly Jarvis and Carr, {James C.} and Collins, {Jeremy D.} and Shyam Prabhakaran and Michael Markl",

note = "Funding Information: Contract grant sponsor: National Institutes of Health (NIH); contract grant numbers: NHLBI grant R21 HL 132357, K25HL119608, AHA 16SDG3042005. Publisher Copyright: {\textcopyright} 2017 International Society for Magnetic Resonance in Medicine",

year = "2018",

month = may,

doi = "10.1002/jmri.25862",

language = "English (US)",

volume = "47",

pages = "1276--1286",

journal = "Journal of Magnetic Resonance Imaging",

issn = "1053-1807",

publisher = "John Wiley and Sons Inc.",

number = "5",

}

Voxel-by-voxel 4D flow MRI-based assessment of regional reverse flow in the aorta. / Shen, Xin; Schnell, Susanne; Barker, Alex J.; Suwa, Kenichiro; Tashakkor, Lingzi; Jarvis, Kelly; Carr, James C.; Collins, Jeremy D.; Prabhakaran, Shyam; Markl, Michael.

In: Journal of Magnetic Resonance Imaging, Vol. 47, No. 5, 05.2018, p. 1276-1286.

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

TY - JOUR

T1 - Voxel-by-voxel 4D flow MRI-based assessment of regional reverse flow in the aorta

AU - Shen, Xin

AU - Schnell, Susanne

AU - Barker, Alex J.

AU - Suwa, Kenichiro

AU - Tashakkor, Lingzi

AU - Jarvis, Kelly

AU - Carr, James C.

AU - Collins, Jeremy D.

AU - Prabhakaran, Shyam

AU - Markl, Michael

N1 - Funding Information: Contract grant sponsor: National Institutes of Health (NIH); contract grant numbers: NHLBI grant R21 HL 132357, K25HL119608, AHA 16SDG3042005. Publisher Copyright: © 2017 International Society for Magnetic Resonance in Medicine

PY - 2018/5

Y1 - 2018/5

N2 - 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.

AB - 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.

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KW - flow

KW - flow reversal

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

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