Time-resolved magnetic resonance angiography and flow-sensitive 4-dimensional magnetic resonance imaging at 3 Tesla for blood flow and wall shear stress.

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Presentation transcript:

Time-resolved magnetic resonance angiography and flow-sensitive 4-dimensional magnetic resonance imaging at 3 Tesla for blood flow and wall shear stress analysis Alex Frydrychowicz, MD, Alexander Berger, Maximilan F. Russe, Aurélien F. Stalder, MS, Andreas Harloff, MD, Sven Dittrich, MD, Jürgen Hennig, PhD, Mathias Langer, MD, MBA, Michael Markl, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 136, Issue 2, Pages 400-407 (August 2008) DOI: 10.1016/j.jtcvs.2008.02.062 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Flow-sensitive 4D MRI at 3T of the aorta and subsequent 3D flow visualization in a healthy volunteer. Measured 3-directional blood flow velocities were visualized using 3D stream-lines depicting systolic flow characteristics in the entire thoracic aorta and supra-aortic branches. Color coding = local velocity magnitude. AAo, Ascending aorta; DAo, descending aorta. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 400-407DOI: (10.1016/j.jtcvs.2008.02.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Maximum intensity projections of 4 (of 20) successive time frames representing the first arterial passage of the contrast agent using time-resolved 3D CE-MRA at 3T with a temporal update rate of 2.8 seconds. A high-grade stenosis of the DAo (white arrow) was revealed in this 13-year-old boy. In addition, marked collateral flow via the intercostal arteries and internal thoracic arteries was observed. AAo, Ascending aorta; DAo, descending aorta; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 400-407DOI: (10.1016/j.jtcvs.2008.02.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Flow-sensitive 4D MRI at 3T and subsequent visualization using 3D streamlines of the aorta in patient with severe descending aortic stenosis. A, Hemodynamics before intervention included vortical and retrograde flow in the AAo (A left, open white arrows) and accelerated flow distal to the stenosis (A right, white arrowheads) in combination with retrograde flow in the posterior part of the vessel (A right, asterisk). Note that 3D flow visualization was hampered by velocity aliasing and the small diameter of the stenosis (bottom middle, white arrow). B, Systolic 3D streamline visualization of the AAo before (A) and 5 (B) and 9 (C) months after stent placement and dilatation. Note the initially large vortex at the inner curvature of the AAo and proximal arch that decreases after dilatation (solid white arrows). Color coding = local velocity magnitude. 3D, 3-dimensional; MRI, magnetic resonance imaging; AAo, ascending aorta; DAo, descending aorta. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 400-407DOI: (10.1016/j.jtcvs.2008.02.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Analysis of WSS and flow quantification: The placement of retrospectively defined 2-dimensional cutplanes transecting the aorta (AAo and DAo) allowed for the quantitative evaluation of blood flow and vessel wall parameters. The selection of cutplanes is illustrated in conjunction with a surface-rendered geometry of the aorta (middle) derived from the same 3D velocity encoded dataset (white arrow = stenosis). Altered hemodynamics led to vortex formation and locally reversed flow in the AAo that eventually induced low and oscillating WSS along the inner wall (Figure 3, top left: green bars: mean segmental vectorial WSS [N/m2], magenta bars: OSI (multiplied by WSS), bottom: flow quantification showing mean flow in [L/s]) if compared with relatively unsuspicious findings in the proximal DAo (right). The results indicate areas susceptible to vascular remodeling at the inner curvature of the AAo if compared with segmentally more constant WSS with a lower OSI in the proximal DAo. WSS, Wall shear stress; 4D, 4-dimensional; MRI, magnetic resonance imaging; AAo, ascending aorta; DAo, descending aorta; OSI, oscillatory shear index. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 400-407DOI: (10.1016/j.jtcvs.2008.02.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Development of segmental wall shear stress (WSS) left and mean blood flow velocities right before intervention (black squares) and after therapy (red diamonds and blue triangles). Data analysis was performed in 2-dimensional cutplanes in the ascending aorta (AAo) and proximal descending aorta (DAo). Left, There were only slight changes in flow velocities 5 months after dilatation. However, a marked improvement of mean flow velocities and volume (area under the curve) was seen 9 months after intervention. Right, Mean descending aortic WSS significantly increased after intervention and was considerably higher for all 12 segments along the aortic lumen circumference 9 months after sent placement. Along the inner curvature of the AAo (segments 5–9, gray shaded area), initially reduced WSS was restored to higher values after intervention. Note the marked alterations of WSS in the patient before and after therapy in comparison with the relatively constant circumferential distribution of WSS in healthy volunteers (green data points). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 400-407DOI: (10.1016/j.jtcvs.2008.02.062) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions