Rapid cardiac-output measurement with ungated spiral phase contrast.

An ungated spiral phase-contrast (USPC) method was used to measure cardiac output (CO) rapidly and conveniently. The USPC method, which was originally designed for small peripheral vessels, was modified to assess CO by measuring flow in the ascending aorta (AA). The modified USPC used a 12-interleaf spiral trajectory to acquire full-image data every 283 ms with 2-mm spatial resolution. The total scan time was 5 s. For comparison, a triggered real-time (TRT) method was used to indirectly calculate CO by measuring left-ventricular (LV) volume. The USPC and TRT measurements from all normal volunteers agreed. In a patient with patent ductus arteriosus (PDA), high CO was measured with USPC, which agreed well with the invasive cardiac-catheterized measurement. In normal volunteers, CO dropped about 20-30% with Valsalva maneuvering, and increased about 100% after exercise. Continuous 28-s cycling between Valsalva maneuvering and free-breathing showed that USPC can temporally resolve physiological CO changes.     

4D phase contrast MRI at 3 T: Effect of standard and blood‐pool contrast agents on SNR,PC‐MRA,and blood flow visualization

Time‐resolved phase contrast (PC) MRI with velocity encoding in three directions (flow‐sensitive four‐dimensional MRI) can be employed to assess three‐dimensional blood flow in the entire aortic lumen within a single measurement. These data can be used not only for the visualization of blood flow but also to derive additional information on vascular geometry with three‐dimensional PC MR angiography (MRA). As PC‐MRA is sensitive to available signal‐to‐noise ratio, standard and novel blood pool contrast agents may help to enhance PC‐MRA image quality. In a group of 30 healthy volunteers, the influence of different contrast agents on vascular signal‐to‐noise ratio, PC‐MRA quality, and subsequent three‐dimensional stream‐line visualization in the thoracic aorta was determined. Flow‐sensitive four‐dimensional MRI data acquired with contrast agent provided significantly improved signal‐to‐noise ratio in magnitude data and noise reduction in velocity data compared to measurements without contrast media. The agreement of three‐dimensional PC‐MRA with reference standard contrast‐enhanced MRA was good for both contrast agents, with improved PC‐MRA performance for blood pool contrast agent, particularly for the smaller supra‐aortic branches. For three‐dimensional flow visualization, a trend toward improved results for the data with contrast agent was observed. Magn Reson Med, 2010. © 2009 Wiley‐Liss, Inc.     

Coronary flow and coronary flow reserve measurements in humans with breath-held magnetic resonance phase contrast velocity mapping

Objective evidence for coronary lesion significance can be obtained with ischemic stress testing. Since flow-limiting stenoses have already undergone compensatory vasodilatation to maintain flow, the response to vasoactive stimulation is dampened. The degree of response limitation is reflected by the coronary flow reserve (CFR). Absolute volume flow rates can be accurately and noninvasively measured with MRI techniques. The purpose was to assess the ability to measure coronary volume flow rate noninvasively, and characterize the effect of pharmacologic stress on coronary flow quantitatively by using ultrafast, breath-held segmented k-space phasecontrast-MR imaging (PC-MRI). Ten healthy volunteers were examined by using ultrafast breath-held PC-MRI. Coronary volume flow rates were measured in the anterior descending coronary artery (LAD) at rest and following intravenous administration of dipyridamole. CFR was determined based on these data. Mean LAD volume flow rates increased from 38 ± 11 ml/min before application of dipyridamole to 169 ± 42 ml/min. The mean CFR amounted to 5.0 ± 2.6 (median = 4.15). This study demonstrates the feasibility of breath-held PC-MRI to noninvasively quantify coronary volume flow rates over the cardiac cycle. Pharmacologically induced changes in volume flow rate and thus CFR can be quantitated.     

Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: Comparison with right heart catheterization and echocardiography

Purpose:

To compare the utility of phase contrast MR imaging (PC‐MRI) for assessment of pulmonary flow and pressure estimation with that of right heart catheterization and echocardiography (cardiac US) in patients with pulmonary arterial hypertension (PAH).

Materials and Methods:

Twenty consecutive patients with suspected PAH underwent PC‐MRI, cardiac US, and right heart catheterization. In each patient, PC‐MRI was acquired by cine 2D‐PC method on a 1.5 Tesla scanner, and stroke volume (SV) and pulmonary arterial systolic pressure (PASP) were assessed by using the modified Bernoulli's equation. To evaluate the agreements of SV and PASP among the three methods, correlations and limits of agreement among the three methods were statistically assessed by using the Bland‐Altman's analyses.

Results:

The correlations and limits of agreement for SV and PASP between PC‐MRI and catheterization (r = 0.96, r² = 0.94, 1.1 ± 6.9 mL and r = 0.94, r² = 0.88, ?3.2 ± 14.5 mmHg, respectively) were better than between cardiac US and catheterization (r = 0.01, r² < 0.01, 8.9 ± 42.1 mL and r = 0.86, r² = 0.72, ?5.9 ± 27.7 mmHg, respectively).

Conclusion:

PC‐MRI is more compatible with right heart catheterization than cardiac US in pulmonary flow and pressure estimation. J. Magn. Reson. Imaging 2009;30:973–980. © 2009 Wiley‐Liss, Inc.

     

Quantitative 2D and 3D phase contrast MRI: Optimized analysis of blood flow and vessel wall parameters

Quantification of CINE phase contrast (PC)‐MRI data is a challenging task because of the limited spatiotemporal resolution and signal‐to‐noise ratio (SNR). The method presented in this work combines B‐spline interpolation and Green's theorem to provide optimized quantification of blood flow and vessel wall parameters. The B‐spline model provided optimal derivatives of the measured three‐directional blood velocities onto the vessel contour, as required for vectorial wall shear stress (WSS) computation. Eight planes distributed along the entire thoracic aorta were evaluated in a 19‐volunteer study using both high‐spatiotemporal‐resolution planar two‐dimensional (2D)‐CINE‐PC (～1.4 × 1.4 mm²/24.4 ms) and lower‐resolution 3D‐CINE‐PC (～2.8 × 1.6 × 3 mm³/48.6 ms) with three‐directional velocity encoding. Synthetic data, error propagation, and interindividual, intermodality, and interobserver variability were used to evaluate the reliability and reproducibility of the method. While the impact of MR measurement noise was only minor, the limited resolution of PC‐MRI introduced systematic WSS underestimations. In vivo data demonstrated close agreement for flow and WSS between 2D‐ and 3D‐CINE‐PC as well as observers, and confirmed the reliability of the method. WSS analysis along the aorta revealed the presence of a circumferential WSS component accounting for 10–20%. Initial results in a patient with atherosclerosis suggest the potential of the method for understanding the formation and progression of cardiovascular diseases. Magn Reson Med 60:1218–1231, 2008. © 2008 Wiley‐Liss, Inc.     

Algorithms for improving calculated streamlines in 3-D phase contrast angiography

Streamline display is a unique alternative to cross-sectional slice or projection display, because streamlines more clearly show the patterns of blood flow within the vessel. Flow patterns associated with atherosclerosis, such as streamline separation and recirculation, can be quickly identified with this display. Streamlines can be calculated using velocity data obtained from 3-D phase contrast angiographic pulse sequences. However, these streamlines often pass through the wall of vessel or show intraluminal sources and sinks of blood. The author has developed iterative least squares algorithms to improve the realism of streamlines. The velocity data is modified so that the resulting streamlines do not pass through the vessel wall and there are no intraluminal sources or sinks. He has applied the algorithms to velocity data obtained from a flow phantom and the carotid arteries of normal volunteers. Streamlines derived from the processed velocity fields are more realistic and provide more precise flow quantitation.     

Experimental study of the effects of “Fractional” gating on flow measurements

Velocity encoded phase imaging is subject to errors from phase and amplitude variations of the k-space data caused by beat-to-beat variations of the flow. Fractional cardiac gating is defined as asynchronous gating with each phase encode step occupying a fixed fraction of the RR interval. The gating fraction is the inverse of the number of phase encode steps taken per RR interval. Studies in normal subjects show that deviations and standard errors of ascending and descending aorta flow measurements are significantly greater with decreased gating fraction. Significant errors occur when gating does not separate systolic and diastolic data. The studies establish a graded trade-off between flow measurement accuracy and precision with imaging time, and show that standard nongated phase contrast measurements of strongly pulsatile flow are unreliable.     

Accelerated aortic flow assessment with compressed sensing with and without use of the sparsity of the complex difference image

Phase contrast (PC) cardiac MR is widely used for the clinical assessment of blood flow in cardiovascular disease. One of the challenges of PC cardiac MR is the long scan time which limits both spatial and temporal resolution. Compressed sensing reconstruction with accelerated PC acquisitions is a promising technique to increase the scan efficiency. In this study, we sought to use the sparsity of the complex difference of the two flow‐encoded images as an additional constraint term to improve the compressed sensing reconstruction of the corresponding accelerated PC data acquisition. Using retrospectively under‐sampled data, the proposed reconstruction technique was optimized and validated in vivo on 15 healthy subjects. Then, prospectively under‐sampled data was acquired on 11 healthy subjects and reconstructed with the proposed technique. The results show that there is good agreement between the cardiac output measurements from the fully sampled data and the proposed compressed sensing reconstruction method using complex difference sparsity up to acceleration rate 5. In conclusion, we have developed and evaluated an improved reconstruction technique for accelerated PC cardiac MR that uses the sparsity of the complex difference of the two flow‐encoded images. Magn Reson Med 70:851–858, 2013. © 2012 Wiley Periodicals, Inc.     

Improved SNR in phase contrast velocimetry with five‐point balanced flow encoding

Phase contrast velocimetry can be utilized to measure complex flow for both quantitative and qualitative assessment of vascular hemodynamics. However, phase contrast requires that a maximum measurable velocity be set that balances noise and phase aliasing. To efficiently reduce noise in phase contrast images, several investigators have proposed extended velocity encoding schemes that use extra encodings to unwrap phase aliasing; however, existing techniques can lead to significant increases in echo and scan time, limiting their clinical benefits. In this work, we have developed a novel five‐point velocity encoding scheme that efficiently reduces noise with minimal increases in scan and echo time. Investigations were performed in phantoms, demonstrating a 63% increase in velocity‐to‐noise ratio compared to standard four‐point encoding schemes. Aortic velocity measurements were performed in healthy volunteers, showing similar velocity‐to‐noise ratio improvements. In those volunteers, it was also demonstrated that, without sacrificing accuracy, low‐resolution images can be used for the fifth encoding point, reducing the scan time penalty from 25% down to less than 1%. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Analysis and correction of gradient nonlinearity and B0 inhomogeneity related scaling errors in two-dimensional phase contrast flow measurements.

Phase contrast flow measurements will be increasingly biased at eccentric positions, where nonlinearity of gradients and inhomogeneity of the main field become important. In theory, they scale the result of phase contrast flow values in two ways: incorrect velocity encoding of moving spins and geometric distortion of the vessel cross-sectional area. A flow phantom, consisting of a 3D grid of interconnected tubes, was used to determine the spatial dependence of the associated scaling factors, which demonstrate that scaling errors in flow can be as large as 20% within the examined volume of 336 x 336 x 336 mm(3). The same phantom was also used to determine and minimize concomitant gradient effects. Correction of the off-center flow values with the local scaling factors and the concomitant gradient phase improves the measurement accuracy substantially, both in the flow phantom and in a volunteer study.     

Accuracy and reproducibility in phase contrast imaging using SENSE.

The purpose of this study was to evaluate the accuracy and reproducibility of phase contrast imaging using the sensitivity encoding (SENSE) method at different reduction factors. Analytical expressions were derived that state how reproducibility is influenced for velocity and flow measurements. Computer simulations, and in vitro and in vivo studies were performed in order to validate these expressions and to assess how accuracy is affected when different reduction factors are applied. It was shown that reproducibility depends on the reduction and geometry factors. Since the geometry factor varies spatially, so does the reproducibility for phase contrast imaging. In areas with high geometry factors, the standard deviation (SD) may become so large that aliasing occurs. The accuracy of phase contrast imaging is not influenced directly when SENSE is used, but may be indirectly influenced due to high SDs of the measured phase that may subsequently cause aliasing. The current results show that it is possible to achieve accurate flow measurements even at high reduction factors. By taking the geometry factor into account, it may be possible to find areas where phase contrast imaging is accurate even at high reduction factors.     

Registration of 3D cerebral vessels with 2D digital angiograms: clinical evaluation

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the accuracy and speed of a new, semiautomatic method of three-dimensional (3D)-two-dimensional (2D) vascular registration. This method should help guide endovascular procedures by allowing interpretation of each digital subtraction angiographic (DSA) image in terms of precreated, 3D vessel trees that contain "parent-child" connectivity information. MATERIALS AND METHODS: Connected, 3D vessel trees were created from segmented magnetic resonance (MR) angiograms. Eleven total DSA images were registered with such trees by using both our method and the current standard (manual registration). The accuracy of each method was compared by using repeated-measures analysis of variance with correction for heterogeneity of variance to evaluate separation of curve pairs on the view plane. Subjective clinical comparisons of the two registration methods were evaluated with the sign test. Registration times were evaluated for both methods and also as a function of the error in the initial estimate of MR angiographic position. RESULTS: The new registration method produced results that were numerically superior to those of manual registration (P < .001) and was subjectively judged to be as good as or better by clinical reviewers. Registration time with the new method was faster (P < .001). If the rotational error in the initial estimate of MR angiographic position is less than 10 degrees around each axis, the registration itself took only 1-2 minutes. CONCLUSION: This method is quicker than and produces results as good as or better than those of manual registration. This method should be able to calculate an initial registration matrix during endovascular embolization and adjust that matrix intermittently with registration updates provided by automatic tracking systems.     

Interleaved echo planar phase contrast angiography

Technical aspects of a new rapid 2D multiplanar phase contrast angiographic sequence are presented. The sequence uses multiple excitation echo planar imaging concepts. The advantage of using multiple excitations is that the resolution can be increased over that obtainable with single shot echo planar imaging. By combining phase contrast measurements with echo planar imaging, the measurement time is considerably reduced compared with conventional phase contrast magnetic resonance angiography. The present implementation still requires some improvements before being suitable for clinical applications. Future embodiments could, however, permit angiograms of vessels subject to respiratory motion.     

High temporal resolution phase contrast MRI with multiecho acquisitions.

Velocity imaging with phase contrast (PC) MRI is a noninvasive tool for quantitative blood flow measurement in vivo. A shortcoming of conventional PC imaging is the reduction in temporal resolution as compared to the corresponding magnitude imaging. For the measurement of velocity in a single direction, the temporal resolution is halved because one must acquire two differentially flow-encoded images for every PC image frame to subtract out non-velocity-related image phase information. In this study, a high temporal resolution PC technique which retains both the spatial resolution and breath-hold length of conventional magnitude imaging is presented. Improvement by a factor of 2 in the temporal resolution was achieved by acquiring the differentially flow-encoded images in separate breath-holds rather than interleaved within a single breath-hold. Additionally, a multiecho readout was incorporated into the PC experiment to acquire more views per unit time than is possible with the single gradient-echo technique. A total improvement in temporal resolution by approximately 5 times over conventional PC imaging was achieved. A complete set of images containing velocity data in all three directions was acquired in four breath-holds, with a temporal resolution of 11.2 ms and an in-plane spatial resolution of 2 mm x 2 mm.