Four-dimensional flow cardiovascular magnetic resonance in aortic dissection: Assessment in an ex vivo model and preliminary clinical experience

Beaufort, Hector W. de; Shah, Dipan J.; Patel, Avni; Jackson, Matthew S.; Spinelli, Domenico; Yang, Eric; Ghosn, Mohamad G.; Autry, Kyle; Igo, Stephen R.; Lumsden, Alan B.; Little, Stephen H.; Trimarchi, Santi; Bismuth, Jean

doi:10.1016/j.jtcvs.2018.06.022

Cited by 26 publications

(17 citation statements)

References 20 publications

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“…This relationship between entry or re‐entry size and flow in TL and FL is already reported by a 4D flow MRI study on 16 patients with abdominal aortic dissection, the intimal entry size being positively correlated with FL net and peak flow, when FL thrombosis was associated with high velocity in the TL . Our results are also in agreement with a recent in vitro and in vivo study involving 14 DAD patients, seven with rTAAD (with prior AAo surgery) and seven with TBAD, who found similar results in terms of difference in forward flow and backward flow between TL and FL (not using parametric mapping) with a good reproducibility; however, there was no comparison between the type of AD . In a recent study of 139 patients after TEVAR, chronic vs. acute DAD, rather than TBAD vs. rTAAD, impacted the procedure success.…”

Section: Discussionsupporting

confidence: 92%

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

Jarvis

Pruijssen

Son

et al. 2019

Magnetic Resonance Imaging

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Background: Systematic evaluation of complex flow in the true lumen and false lumen (TL, FL) is needed to better understand which patients with chronic descending aortic dissection (DAD) are predisposed to complications. Purpose: To develop quantitative hemodynamic maps from 4D flow MRI for evaluating TL and FL flow characteristics. Study Type: Retrospective. Population: In all, 20 DAD patients (age = 60 AE 11 years; 12 male) (six medically managed type B AD [TBAD], 14 repaired type A AD [rTAAD] now with ascending aortic graft [AAo] or elephant trunk [ET1] repair) and 21 age-matched controls (age = 59 AE 10 years; 13 male) were included. Field Strength/Sequence: 1.5T, 3T, 4D flow MRI. Assessment: 4D flow MRI was acquired in all subjects. Data analysis included 3D segmentation of TL and FL and voxelwise calculation of forward flow, reverse flow, flow stasis, and kinetic energy as quantitative hemodynamics maps. Statistical Tests: Analysis of variance (ANOVA) or Kruskal-Wallis tests were performed for comparing subject groups. Correlation and Bland-Altman analysis was performed for the interobserver study. Results: Patients with rTAAD presented with elevated TL reverse flow (AAo repair: P = 0.004, ET1: P = 0.018) and increased TL kinetic energy (AAo repair: P = 0.0002, ET1: P = 0.011) compared to controls. In addition, TL kinetic energy was increased vs. patients with TBAD (AAo repair: P = 0.021, ET1: P = 0.048). rTAAD was associated with higher FL kinetic energy and lower FL stasis compared to patients with TBAD (AAo repair: P = 0.002, ET1: P = 0.024 and AAo repair: P = 0.003, ET1: P = 0.048, respectively). Data Conclusion: Quantitative maps from 4D flow MRI demonstrated global and regional hemodynamic differences between DAD patients and controls. Patients with rTAAD vs. TBAD had significantly altered regional TL and FL hemodynamics. These findings indicate the potential of 4D flow MRI-derived hemodynamic maps to help better evaluate patients with DAD.

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Section: Discussionsupporting

confidence: 92%

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

Jarvis

Pruijssen

Son

et al. 2019

Magnetic Resonance Imaging

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“…4 In the current era of precision medicine, 4D flow MRI holds the potential to characterize novel sequelae of aortic pathologies and thus inform physiologically tailored surgical decision making. The current study of de Beaufort and colleagues, 1 provides key validation of this powerful technique, justifying the need for further studies to test the incremental utility of 4D flow with respect to guidance of interventional strategies and prediction of surgical outcomes.…”

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confidence: 85%

“…This important study expands on previous 4D flow work, including investigations examining aneurysm pathogenesis in bicuspid aortic valves 2 and research by our group, which used 4D flow to address physiologic consequences of recreation of the sinuses of Valsalva during valve-sparing surgery. 3 The topic of aortic dissection, as addressed by de Beaufort and colleagues, 1 represents one in which current surgical treatment indications are based on nonspecific symptoms or anatomic criteria that can be imprecise with respect to longitudinal risk for aortic growth and dissection expansion.…”

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confidence: 99%

Four-dimensional flow magnetic resonance imaging: Beyond beautiful pictures!

Weinsaft

Gaudino

Girardi

2019

The Journal of Thoracic and Cardiovascular Surgery

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“…4D Flow derived hemodynamic parameters such as false lumen stroke volume and velocity, distal dominant entry tears, and helical flow in the false lumen have been shown to correlate with the rate of aortic expansion. (7–11) Furthermore, due to pressure gradients across the dissection flap, small fenestrations can produce comparatively larger flow jets that can be detected by 4D flow MRI. In this study, we hypothesized that 4D flow MRI will allow for superior dissection flap fenestration identification relative to standard MRI/MR angiography (MRA) approaches and provide similar fenestration counts to CTA.…”

Section: Introductionmentioning

confidence: 99%

Detection and Hemodynamic Evaluation of Flap Fenestrations in Type B Aortic Dissection with 4D Flow MRI: Comparison with Conventional MRI and CT Angiography

Allen

Aouad

Burris

et al. 2019

Radiology: Cardiothoracic Imaging

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Purpose: The purpose of this study was to compare dissection flap fenestration visualization between 4D flow MRI, clinical MRI/MRA, and clinical CTA studies and describe the presence of hemodynamically active fenestration flow using 4D flow. Materials and Methods: Nineteen patients with type B dissection (age: 57±5 years) who had undergone standard of-care MRI/MRA of the chest including 4D flow MRI were retrospectively identified. Fourteen of the 19 patients also had CTA performed within 2 years of the MRI/MRA study with no interval surgery. Image review was performed independently by two radiologists. The number of fenestrations (including entry and exit tears), location, and flow directionality were recorded. Differences in the rate of detection between techniques was assessed using a Wilcoxon signed rank test. Results: 4D flow detected more fenestrations relative to MRI/MRA [rev 1: +3 (10%), rev 2: +5 (20%)]. There were similar numbers of fenestrations detected by 4D flow relative to CTA [rev 1: +1 (4%), rev 2: −3 (−12%)]. MRI/MRA detected fewer fenestration relative to CTA in this cohort [rev 1: −6 (−24%), rev 2: −5 (−19%)]. No differences were significant. Combining 4D flow and MRI/MRA resulted in additional fenestration detection. Most fenestrations demonstrated biphasic flow over the cardiac cycle (flow entering false lumen in systole and exiting during diastole, rev 1:18/33, rev 2: 16/30). Conclusions: 4D flow MRI can detect small flap fenestration in type B dissection patients while providing additional information about flow through fenestrations throughout the cardiac cycle relative to CTA and conventional MRI.

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Four-dimensional flow cardiovascular magnetic resonance in aortic dissection: Assessment in an ex vivo model and preliminary clinical experience

Abstract: Four-dimensional flow cardiovascular magnetic resonance is feasible in patients with aortic dissection and can reliably assess flow in the true and false lumens of the aorta. This promotes potential future work on functional assessment of aortic dissection hemodynamics.

Cited by 26 publications

References 20 publications

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

Parametric Hemodynamic 4D Flow MRI Maps for the Characterization of Chronic Thoracic Descending Aortic Dissection

Four-dimensional flow magnetic resonance imaging: Beyond beautiful pictures!

Detection and Hemodynamic Evaluation of Flap Fenestrations in Type B Aortic Dissection with 4D Flow MRI: Comparison with Conventional MRI and CT Angiography

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