Multicenter Consistency Assessment of Valvular Flow Quantification With Automated Valve Tracking in 4D Flow CMR

Juffermans, Joe F; Minderhoud, Savine C S; Wittgren, Johan; Kilburg, Anton; Ese, Amir; Fidock, Benjamin; Zheng, Yu Cong; Zhang, Junmei; Blanken, Carmen P.S.; Lamb, Hildo J.; Goeman, Jelle J.; Carlsson, Marcus; Zhao, Shihua; Planken, R. Nils; Ooij, Pim van; Zhong, Liang; Chen, Xiuyu; Garg, Pankaj; Emrich, Tilman; Hirsch, Alexander; Töger, Johannes; Westenberg, Jos J.M.

doi:10.1016/j.jcmg.2020.12.014

Cited by 30 publications

(28 citation statements)

References 24 publications

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“…A previous multicentre study demonstrated that automated valve tracking on CAAS can provide consistent valvular flow quantification 9 . Our study complements their work and demonstrates interoperability between different CMR methods of MR quantification.…”

Section: Discussionmentioning

confidence: 98%

Mitral regurgitation quantification by cardiac magnetic resonance imaging (MRI) remains reproducible between software solutions

et al. 2022

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Background: The reproducibility of mitral regurgitation (MR) quantification by cardiovascular magnetic resonance (CMR) imaging using different software solutions remains unclear. This research aimed to investigate the reproducibility of MR quantification between two software solutions: MASS (version 2019 EXP, LUMC, Netherlands) and CAAS (version 5.2, Pie Medical Imaging). Methods: CMR data of 35 patients with MR (12 primary MR, 13 mitral valve repair/replacement, and ten secondary MR) was used. Four methods of MR volume quantification were studied, including two 4D-flow CMR methods (MRMVAV and MRJet) and two non-4D-flow techniques (MRStandard and MRLVRV). We conducted within-software and inter-software correlation and agreement analyses. Results: All methods demonstrated significant correlation between the two software solutions: MRStandard (r=0.92, p<0.001), MRLVRV (r=0.95, p<0.001), MRJet (r=0.86, p<0.001), and MRMVAV (r=0.91, p<0.001). Between CAAS and MASS, MRJet and MRMVAV, compared to each of the four methods, were the only methods not to be associated with significant bias. Conclusions: We conclude that 4D-flow CMR methods demonstrate equivalent reproducibility to non-4D-flow methods but greater levels of agreement between software solutions.

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Section: Discussionmentioning

confidence: 98%

Mitral regurgitation quantification by cardiac magnetic resonance imaging (MRI) remains reproducible between software solutions

et al. 2022

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“…First, it was a single-center, small sample study, with an age difference between the AF and healthy groups. Hence, we adopted multivariable linear regression to adjusted age confounders and compared with previous study [11] to explore the age in uence on ow component. Small sample size limited linear regression model effect.…”

Section: Limitationmentioning

confidence: 99%

“…However, few studies reported ventricular function evaluation in AF rhythm through 4D ow. A technique named ow component showed much advanced practical meaning in normal and disease states [10,11]. It enables visualization of three multidimensional images of ow that allow quanti cation of intraventricular blood ow; it may re ect changes in left ventricle (LV) con guration, myocardial function, and pressure distribution within the disease, eventually associated with LV function [12].…”

Section: Introductionmentioning

confidence: 99%

4D Flow Component Reveals Left Ventricular Function In Atrial Fibrillation

Zhao

Chen

Jin

et al. 2022

Preprint

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Purpose: Applicating cardiovascular magnetic resonance (CMR) 4D flow to evaluate left ventricular systolic and diastolic function in atrial fibrillation (AF).Methods: In this study, from May 2021 to October 2021, 26 AF patients and 15 healthy participants were recruited and underwent multiparametric CMR and echocardiogram scans before discharge. The CMR protocol incorporated an assessment of 4D flow, cardiac function. Notably, the AF patients maintained irregular heart rhythm during the CMR scan. The 4D flow components were compared with echocardiogram results.Results: AF patients had a lower proportion of direct flow (33.5% (8.43; 47.5) in AF vs. 69.1% (63.4; 74.4) in healthy), higher delayed ejection (24.1±12% in AF vs. 14.7±6.8% in healthy), retained inflow (32.5% (24.6; 36.9) in AF vs. 14.5% (12.5; 18.2) in healthy) and residual volume (4.73% (1.47; 15.0) in AF vs. 0.62% (0.46; 1.62) in healthy). A high correlation was observed between flow EF and CMR EF (R=0.78, P<0.001) in AF patients. The mean bias among the methods was higher for flow EF than CMR EF (24.86%). Multivariable linear regression showed that the correlation between retained inflow and E/e’ (β=0.152, P=0.048) remained significant when adjusted for confounders. Direct flow (β= -0.170, P=0.038) and retained inflow (β=0.350, P=0.024) significantly correlated with the Minnesota Living with Heart Failure Questionnaire score. Conclusion: CMR 4D flow component revealed a significantly different flow pattern in AF patients compared with healthy participants and provided de novo flow biomarker indicating LV systolic function (direct flow and flow EF) and diastolic function (retained inflow).

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“…In this context, whole-heart 4D flow MRI has been used for the identification of helical and vortical flow patterns, increased flow velocities, regions of elevated wall shear stress, and valvular regurgitation. [3][4][5][6][7][8][9] Advanced acquisition strategies have enabled whole-heart coverage at scan times of $10 minutes, 7,9,10 such that the acquisition can be performed in addition to existing clinical protocols. A recently introduced pseudo-spiral Cartesian sampling strategy with random undersampling in time and compressed sensing (CS) reconstruction has facilitated accurate and repeatable 4D flow MRI in the aorta, carotid arteries, and intracranial arteries.…”

Section: Introductionmentioning

confidence: 99%

Whole‐Heart 4D Flow MRI for Evaluation of Normal and Regurgitant Valvular Flow: A Quantitative Comparison Between Pseudo‐Spiral Sampling and EPI Readout

Blanken

Gottwald

Westenberg

et al. 2021

Magnetic Resonance Imaging

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Background: Pseudo-spiral Cartesian sampling with compressed sensing reconstruction has facilitated highly accelerated 4D flow magnetic resonance imaging (MRI) in various cardiovascular structures. However, unlike echo planar imaging (EPI)accelerated 4D flow MRI, it has not been validated in whole-heart applications. Hypothesis: Pseudo-spiral 4D flow MRI (PROUD [PROspective Undersampling in multiple Dimensions]) is comparable to EPI in robustness of valvular flow measurements and remains comparable as the undersampling factor is increased and scan time reduced. Study Type: Prospective. Population: Twelve healthy subjects and eight patients with valvular regurgitation. Field Strength/Sequence: 3.0 T; PROUD and EPI 4D flow sequences, 2D flow and balanced steady-state free precession sequences. Assessment: Valvular blood flow was quantified using valve tracking. PROUD-and EPI-based measurements of aortic (AV) and pulmonary (PV) flow volumes and left and right ventricular stroke volumes were tested for agreement with 2D MRI-based measurements. PROUD reconstructions with undersampling factors (R) of 9, 14, 28, and 56 were tested for intervalve consistency (per valve, compared to the other valves) and preservation of peak velocities and E/A ratios. Statistical Tests: We used repeated measures ANOVA, Bland-Altman, Wilcoxon signed rank, and intraclass correlation coefficients. P < 0.05 was considered statistically significant. Results: PROUD and EPI intervalve consistencies were not significantly different both in healthy subjects (valve-averaged mean difference [limits of agreement width]: 3.2 AE 0.8 [8.7 AE 1.1] mL/beat for PROUD, 5.5 AE 2.9 [13.7 AE 2.3] mL/beat for EPI, P = 0.07) and in patients with valvular regurgitation (2.3 AE 1.2 [15.3 AE 5.9] mL/beat for PROUD, 0.6 AE 0.6 [19.3 AE 2.9] mL/beat for EPI, P = 0.47). Agreement between EPI and PROUD was higher than between 4D flow (EPI or PROUD) and 2D MRI for forward flow, stroke volumes, and regurgitant volumes. Up to R = 28 in healthy subjects and R = 14 in patients with valvular regurgitation, PROUD intervalve consistency remained comparable to that of EPI. Peak velocities and E/A ratios were preserved up to R = 9. Conclusion: PROUD is comparable to EPI in terms of intervalve consistency and may be used with higher undersampling factors to shorten scan times further.

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Multicenter Consistency Assessment of Valvular Flow Quantification With Automated Valve Tracking in 4D Flow CMR

Cited by 30 publications

References 24 publications

Mitral regurgitation quantification by cardiac magnetic resonance imaging (MRI) remains reproducible between software solutions

Mitral regurgitation quantification by cardiac magnetic resonance imaging (MRI) remains reproducible between software solutions

4D Flow Component Reveals Left Ventricular Function In Atrial Fibrillation

Whole‐Heart 4D Flow MRI for Evaluation of Normal and Regurgitant Valvular Flow: A Quantitative Comparison Between Pseudo‐Spiral Sampling and EPI Readout

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