Initial experience characterizing a type I endoleak from velocity profiles using time- resolved three-dimensional phase-contrast MRI Thomas A. Hope, MD,

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Presentation transcript:

Initial experience characterizing a type I endoleak from velocity profiles using time- resolved three-dimensional phase-contrast MRI Thomas A. Hope, MD, Christopher K. Zarins, MD, Robert J. Herfkens, MD Journal of Vascular Surgery Volume 49, Issue 6, Pages 1580-1584 (June 2009) DOI: 10.1016/j.jvs.2009.01.010 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 Time-resolved three-dimensional phase-contrast magnetic resonance imaging (MRI) or 4D flow acquisition. Phase contrast MRI allows for the acquisition of velocity encoded images by applying bipolar gradients. For each phase encode (represented by a large square), a reference image and three velocity components are acquired. In this acquisition, four phase encodes were acquired and then repeated throughout each cardiac cycle determining the temporal resolution (65 ms in this case). During the next cardiac cycle, four different phase encodes were acquired until the entirety of k-space was acquired. Data is grouped based on when it was acquired in the cardiac cycle to reconstruct a temporally resolved data set (Adapted from Markl et al 2003).1 Journal of Vascular Surgery 2009 49, 1580-1584DOI: (10.1016/j.jvs.2009.01.010) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 Volume rendered computed tomography angiography depicting the location of the endografts as well as the femoral-femoral bypass. Journal of Vascular Surgery 2009 49, 1580-1584DOI: (10.1016/j.jvs.2009.01.010) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 4D flow acquisition depicting blood flow through the endograft at peak systole (left). Speed is depicted by the color of the streamlines. The arrowhead points to the superior mesenteric artery, while the arrow points to flow entering the type I endoleak. Planes used for calculation of mean velocities are labeled (planes A-D). Streamlines continue only into the right iliac artery as there is a limb occluder in original left graft limb. MRA curved-planar reformation through the abdominal aorta and right iliac graft shows corresponding contrast in the proximal neck of the aneurysm supporting the diagnosis of a type I endoleak (right). Journal of Vascular Surgery 2009 49, 1580-1584DOI: (10.1016/j.jvs.2009.01.010) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 4 Oblique sagittal view of 4D flow streamlines depicting flow into the aneurysm sac. A semitransparent axial plane through the proximal neck of aneurysm shows contrast outside of the vessel lumen. Streamlines exit the vessel and enter the aneurysm sac posteriorly (arrows). Streamlines continue through the patent endograft lumen (arrowheads). Journal of Vascular Surgery 2009 49, 1580-1584DOI: (10.1016/j.jvs.2009.01.010) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 5 Chart of mean velocities across the aortic lumen and the inlet of the proximal type I endoleak as described in Fig 3. Suprarenal aortic velocity profiles are similar to the proximal portion of the endograft, 14 and 13 cm/s, respectively (planes A and C). There is net flow into the inlet of the endoleak with a maximum velocity of 7 cm/s, and there is no retrograde flow during diastole (plane B). In the distal graft (plane D), velocities increase significantly to a maximum of 48 cm/s due to tapering, and there is a significant amount of retrograde flow in early diastole due to the decreased distensibility compared with the native vessel wall. Journal of Vascular Surgery 2009 49, 1580-1584DOI: (10.1016/j.jvs.2009.01.010) Copyright © 2009 Society for Vascular Surgery Terms and Conditions