Cardiovascular applications of magnetic resonance flow and velocity measurements

Assessment of coronary flow velocity reserve with phase-contrast cine magnetic resonance imaging in patients with heavy coronary calcification

Coronary flow velocity reserve (CFVR) can be noninvasively measured by phase-contrast cine magnetic resonance imaging (PC-MRI). Heavy coronary calcification degrades the diagnostic accuracy for the detection of coronary arterial stenosis on computed tomography (CT). The aim of this study was to evaluate the value of CFVR measurement with PC-MRI for detecting significant coronary stenoses in patients with heavy coronary calcification. Sixteen patients (71 ± 8 years) with coronary calcium score above 400 who had suspected moderate coronary stenosis (50-69% diameter stenosis) on CT angiography were prospectively studied. The CFVR values, calculated as the ratio of peak flow velocity during hyperemia to the peak flow velocity at rest, were measured using breath-hold PC-MRI with 3 T system, and were compared with the results of quantitative coronary angiography (QCA). The mean coronary calcium score was 985 ± 378. CFVR was successfully determined with PC-MRI in 17/18 (94%) vessels. Using a threshold of 1.4 for CFVR, the sensitivity, specificity, and positive and negative predictive value for detecting ≥ 50% stenosis on QCA was 88% (7/8), 89% (8/9), 88% (7/8), 89% (8/9), respectively. When MRI CFVR measurements was added to CT angiography for the evaluation of coronary stenosis, the positive predictive value was 88% (7/8), while the positive predictive value of CT angiography alone was 44% (8/18). PC-MRI can provide noninvasive detection of altered CFVR caused by significant stenosis in patient. CFVR measurement by PC-MRI is useful for diagnosing physiologically significant coronary stenosis in patients with high calcium score on CT.

Fully coupled fluid-electro-mechanical model of the human heart for supercomputers

In this work, we present a fully coupled fluid-electro-mechanical model of a 50th percentile human heart. The model is implemented on Alya, the BSC multi-physics parallel code, capable of running efficiently in supercomputers. Blood in the cardiac cavities is modeled by the incompressible Navier-Stokes equations and an arbitrary Lagrangian-Eulerian (ALE) scheme. Electrophysiology is modeled with a monodomain scheme and the O'Hara-Rudy cell model. Solid mechanics is modeled with a total Lagrangian formulation for discrete strains using the Holzapfel-Ogden cardiac tissue material model. The three problems are simultaneously and bidirectionally coupled through an electromechanical feedback and a fluid-structure interaction scheme. In this paper, we present the scheme in detail and propose it as a computational cardiac workbench.

Clinical manifestations, diagnosis, and treatment of ischemic mitral regurgitation: a review

Ischemic mitral regurgitation (IMR) is a frequent complication after acute myocardial infarction (AMI) associated with a worse prognosis. The pathophysiological mechanisms of IMR are not fully understood, but it is known to be a complex process in which ventricular remodelling is the main causal factor. The various imaging techniques in cardiology and echocardiography fundamentally have contributed significantly to clarify the mechanisms that cause and progressively aggravate IMR. At present, different therapeutic options, the most important of which are cardio-surgical, address this problem. Nowadays the improvement in cardiac surgery and transcatheter therapies, have shown a therapeutic advance in IMR management. IMR is a predictor of poor prognosis in patients with heart failure and depressed left ventricular (LV) systolic function. However, it remains controversial whether mitral regurgitation (MR) in these patients is a consequence of dilation and dysfunction of the LV, or whether it contributes to worsening the prognosis of the ventricular dysfunction. Given that echocardiography has a fundamental reference role in the identification, graduation of severity and evaluation of the therapeutics used in the treatment of MR, we are going to focus on it over the rest of the imaging techniques. In contrast to primary MR the benefits of mitral surgery in patients with secondary MR are uncertain. Therefore, we will comment fundamentally on the role of mitral surgery in patients with IMR, with an update of the different surgical interventions available, without forgetting to mention the other therapeutic options currently available.

[An Examination of Variable Image Positions in the Aortic Valve Blood Flow Using Phase Contrast MRI: Effect of Breath-holding Methods in Healthy Volunteers]

Phase contrast MRI (PC-MRI) is a useful tool for evaluating valvular pathology. In addition, PC-MRI can provide a noninvasive assessment of blood flow in an arbitrary cross section. However, the blood flow measurement with breath-hold or free breath PC-MRI may be different from each other because of intrathoracic pressure changing and variable image position. The aim of this study was to find both the optimal breath-hold technique and the image position. Quantitative flow images were acquired in four planes (ascending aorta: Ao, sino-tubular junction: STJ, valsalva sinus: valsalva, left ventricular outflow tract: LVOT), in healthy subjects (n=10). The study protocol was divided into two parts: (1) stroke volume (SV) measured in each slice positions by using inspiration, expiration, and navigation method during normal breathing and (2) SV measured at each breath-hold techniques in the Ao, STJ, valsalva, and LVOT. As a result, (1) SV of the respective measurement positions were not significant by using inspiration, expiration, and navigation method and (2) LVOT SV was significantly lower than Ao, STJ, and valsalva.

Optimal sampling with prior information of the image geometry in microfluidic MRI

Recent advances in MRI acquisition for microscopic flows enable unprecedented sensitivity and speed in a portable NMR/MRI microfluidic analysis platform. However, the application of MRI to microfluidics usually suffers from prolonged acquisition times owing to the combination of the required high resolution and wide field of view necessary to resolve details within microfluidic channels. When prior knowledge of the image geometry is available as a binarized image, such as for microfluidic MRI, it is possible to reduce sampling requirements by incorporating this information into the reconstruction algorithm. The current approach to the design of the partial weighted random sampling schemes is to bias toward the high signal energy portions of the binarized image geometry after Fourier transformation (i.e. in its k-space representation). Although this sampling prescription is frequently effective, it can be far from optimal in certain limiting cases, such as for a 1D channel, or more generally yield inefficient sampling schemes at low degrees of sub-sampling. This work explores the tradeoff between signal acquisition and incoherent sampling on image reconstruction quality given prior knowledge of the image geometry for weighted random sampling schemes, finding that optimal distribution is not robustly determined by maximizing the acquired signal but from interpreting its marginal change with respect to the sub-sampling rate. We develop a corresponding sampling design methodology that deterministically yields a near optimal sampling distribution for image reconstructions incorporating knowledge of the image geometry. The technique robustly identifies optimal weighted random sampling schemes and provides improved reconstruction fidelity for multiple 1D and 2D images, when compared to prior techniques for sampling optimization given knowledge of the image geometry.

Inlet and outlet valve flow and regurgitant volume may be directly and reliably quantified with accelerated, volumetric phase-contrast MRI

PURPOSE

To determine whether it is feasible to use solely an accelerated 4D phase-contrast magnetic resonance imaging (4D-PC MRI) acquisition to quantify net and regurgitant flow volume through each of the cardiac valves.

MATERIALS AND METHODS

Accelerated, 4D-PC MRI examinations performed between March 2010 through June 2011 as part of routine MRI examinations for congenital, structural heart disease were retrospectively reviewed and analyzed using valve-tracking visualization and quantification algorithms developed in Java and OpenGL. Excluding patients with transposition or single ventricle physiology, a total of 34 consecutive pediatric patients (19 male, 15 female; mean age 6.9 years; age range 10 months to 15 years) were identified. 4D-PC flow measurements were compared at each valve and against routine measurements from conventional cardiac MRI using Bland-Altman and Pearson correlation analysis.

RESULTS

Inlet and outlet valve net flow were highly correlated between all valves (P = 0.940-0.985). The sum of forward flow at the outlet valve and regurgitant flow at the inlet valve were consistent with volumetric displacements in each ventricle (P = 0.939-0.948). These were also highly consistent with conventional planar MRI measurements with net flow (P = 0.923-0.935) and regurgitant fractions (P = 0.917-0.972) at the outlet valve and ventricular volumes (P = 0.925-0.965).

CONCLUSION

It is possible to obtain consistent measurements of net and regurgitant blood flow across the inlet and outlet valves relying solely on accelerated 4D-PC. This may facilitate more efficient clinical quantification of valvular regurgitation.

Assessment of renal function; clearance, the renal microcirculation, renal blood flow, and metabolic balance

Historically, tools to assess renal function have been developed to investigate the physiology of the kidney in an experimental setting, and certain of these techniques have utility in evaluating renal function in the clinical setting. The following work will survey a spectrum of these tools, their applications and limitations in four general sections. The first is clearance, including evaluation of exogenous and endogenous markers for determining glomerular filtration rate, the adaptation of estimated glomerular filtration rate in the clinical arena, and additional clearance techniques to assess various other parameters of renal function. The second section deals with in vivo and in vitro approaches to the study of the renal microvasculature. This section surveys a number of experimental techniques including corticotomy, the hydronephrotic kidney, vascular casting, intravital charge coupled device videomicroscopy, multiphoton fluorescent microscopy, synchrotron-based angiography, laser speckle contrast imaging, isolated renal microvessels, and the perfused juxtamedullary nephron microvasculature. The third section addresses in vivo and in vitro approaches to the study of renal blood flow. These include ultrasonic flowmetry, laser-Doppler flowmetry, magnetic resonance imaging (MRI), phase contrast MRI, cine phase contrast MRI, dynamic contrast-enhanced MRI, blood oxygen level dependent MRI, arterial spin labeling MRI, x-ray computed tomography, and positron emission tomography. The final section addresses the methodologies of metabolic balance studies. These are described for humans, large experimental animals as well as for rodents. Overall, the various in vitro and in vivo topics and applications to evaluate renal function should provide a guide for the investigator or physician to understand and to implement the techniques in the laboratory or clinic setting.

In vitro validation of flow measurement with phase contrast MRI at 3 tesla using stereoscopic particle image velocimetry and stereoscopic particle image velocimetry-based computational fluid dynamics

PURPOSE

To validate conventional phase-contrast MRI (PC-MRI) measurements of steady and pulsatile flows through stenotic phantoms with various degrees of narrowing at Reynolds numbers mimicking flows in the human iliac artery using stereoscopic particle image velocimetry (SPIV) as gold standard.

MATERIALS AND METHODS

A series of detailed experiments are reported for validation of MR measurements of steady and pulsatile flows with SPIV and CFD on three different stenotic models with 50%, 74%, and 87% area occlusions at three sites: two diameters proximal to the stenosis, at the throat, and two diameters distal to the stenosis.

RESULTS

Agreement between conventional spin-warp PC-MRI with Cartesian read-out and SPIV was demonstrated for both steady and pulsatile flows with mean Reynolds numbers of 130, 160, and 190 at the inlet by evaluating the linear regression between the two methods. The analysis revealed a correlation coefficient of > 0.99 and > 0.96 for steady and pulsatile flows, respectively. Additionally, it was found that the most accurate measures of flow by the sequence were at the throat of the stenosis (error < 5% for both steady and pulsatile mean flows). The flow rate error distal to the stenosis was primarily found to be a function of narrowing severity including dependence on proper Venc selection.

CONCLUSION

SPIV and CFD provide excellent approaches to in vitro validation of new or existing PC-MRI flow measurement techniques.

Venous and arterial flow quantification are equally accurate and precise with parallel imaging compressed sensing 4D phase contrast MRI

PURPOSE

To evaluate the precision and accuracy of parallel-imaging compressed-sensing 4D phase contrast (PICS-4DPC) magnetic resonance imaging (MRI) venous flow quantification in children with patients referred for cardiac MRI at our children's hospital.

MATERIALS AND METHODS

With Institutional Review Board (IRB) approval and Health Insurance Portability and Accountability Act (HIPAA) compliance, 22 consecutive patients without shunts underwent 4DPC as part of clinical cardiac MRI examinations. Flow measurements were obtained in the superior and inferior vena cava, ascending and descending aorta, and the pulmonary trunk. Conservation of flow to the upper, lower, and whole body was used as an internal physiologic control. The arterial and venous flow rates at each location were compared with paired t-tests and F-tests to assess relative accuracy and precision.

RESULTS

Arterial and venous flow measurements were strongly correlated with the upper (ρ = 0.89), lower (ρ = 0.96), and whole body (ρ = 0.97); net aortic and pulmonary trunk flow rates were also tightly correlated (ρ = 0.97). There was no significant difference in the value or precision of arterial and venous flow measurements in upper, lower, or whole body, although there was a trend toward improved precision with lower velocity-encoding settings.

CONCLUSION

With PICS-4DPC MRI, the accuracy and precision of venous flow quantification are comparable to that of arterial flow quantification at velocity-encodings appropriate for arterial vessels.

Rapid pediatric cardiac assessment of flow and ventricular volume with compressed sensing parallel imaging volumetric cine phase-contrast MRI

OBJECTIVE

The quantification of cardiac flow and ventricular volumes is an essential goal of many congenital heart MRI examinations, often requiring acquisition of multiple 2D phase-contrast and bright-blood cine steady-state free precession (SSFP) planes. Scan acquisition, however, is lengthy and highly reliant on an imager who is well-versed in structural heart disease. Although it can also be lengthy, 3D time-resolved (4D) phase-contrast MRI yields global flow patterns and is simpler to perform. We therefore sought to accelerate 4D phase contrast and to determine whether equivalent flow and volume measurements could be extracted.

MATERIALS AND METHODS

Four-dimensional phase contrast was modified for higher acceleration with compressed sensing. Custom software was developed to process 4D phase-contrast images. We studied 29 patients referred for congenital cardiac MRI who underwent a routine clinical protocol, including cine short-axis stack SSFP and 2D phase contrast, followed by contrast-enhanced 4D phase contrast. To compare quantitative measurements, Bland-Altman analysis, paired Student t tests, and F tests were used.

RESULTS

Ventricular end-diastolic, end-systolic, and stroke volumes obtained from 4D phase contrast and SSFP were well correlated (ρ = 0.91-0.95; r(2) = 0.83-0.90), with no statistically significant difference. Ejection fractions were well correlated in a subpopulation that underwent higher-resolution compressed-sensing 4D phase contrast (ρ = 0.88; r(2) = 0.77). Four-dimensional phase contrast and 2D phase contrast flow rates were also well correlated (ρ = 0.90; r(2) = 0.82). Excluding ventricles with valvular insufficiency, cardiac outputs derived from outlet valve flow and stroke volumes were more consistent by 4D phase contrast than by 2D phase contrast and SSFP.

CONCLUSION

Combined parallel imaging and compressed sensing can be applied to 4D phase contrast. With custom software, flow and ventricular volumes may be extracted with comparable accuracy to SSFP and 2D phase contrast. Furthermore, cardiac outputs were more consistent by 4D phase contrast.

Compressive sampling with prior information in remotely detected MRI of microfluidic devices

The design and operation of microfluidic analytical devices depends critically on tools to probe microscale chemistry and flow dynamics. Magnetic resonance imaging (MRI) seems ideally suited to this task, but its sensitivity is compromised because the fluid-containing channels in "lab on a chip" devices occupy only a small fraction of the enclosing detector's volume; as a result, the few microfluidic applications of NMR have required custom-designed chips harboring many detectors at specific points of interest. To overcome this limitation, we have developed remotely detected microfluidic MRI, in which an MR image is stored in the phase and intensity of each analyte's NMR signal and sensitively detected by a single, volume-matched detector at the device outflow, and combined it with compressed sensing for rapid image acquisition. Here, we build upon our previous work and introduce a method that incorporates our prior knowledge of the microfluidic device geometry to further decrease acquisition times. We demonstrate its use in multidimensional velocimetric imaging of a microfluidic mixer, acquiring microscopically detailed images 128 times faster than is possible with conventional sampling. This prior information also informs our choice of sampling schedule, resulting in a scheme that is optimized for a specific flow geometry. Finally, we test our approach in synthetic data and explore potential reconstruction errors as a function of optimization and reconstruction parameters.

The role of cardiovascular magnetic resonance in pediatric congenital heart disease

Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.

Improved cardiovascular flow quantification with time-resolved volumetric phase-contrast MRI

BACKGROUND

Cardiovascular flow is commonly assessed with two-dimensional, phase-contrast MRI (2-D PC-MRI). However, scan prescription and acquisition over multiple planes is lengthy, often requires direct physician oversight and has inconsistent results. Time-resolved volumetric PC-MRI (4-D flow) may address these limitations.

OBJECTIVE

We assess the degree of agreement and internal consistency between 2-D and 4-D flow quantification in our clinical population.

MATERIALS AND METHODS

Software enabling flow calculation from 4-D flow was developed in Java. With IRB approval and HIPAA compliance, 18 consecutive patients without shunts were identified who underwent both (1) conventional 2-D PC-MRI of the aorta and main pulmonary artery and (2) 4-D flow imaging. Aortic and pulmonary flow rates were assessed with both techniques.

RESULTS

Both methods showed general agreement in flow rates (ρ: 0.87-0.90). Systemic and pulmonary arterial flow rates were well-correlated (ρ: 4-D 0.98-0.99, 2-D 0.93), but more closely matched with 4-D (P < 0.05, Brown-Forsythe). Pulmonary flow rates were lower than systemic rates for 2-D (P < 0.05, two-sample t-test). In a sub-analysis of patients without pulmonary or aortic regurgitation, 2-D showed improved correlation of flow rates while 4-D phase-contrast remained tightly correlated (ρ: 4-D 0.99-1.00, 2-D 0.99).

CONCLUSION

4-D PC-MRI demonstrates greater consistency than conventional 2-D PC-MRI for flow quantification.

Optimized parallel imaging for dynamic PC-MRI with multidirectional velocity encoding

Phase contrast MRI with multidirectional velocity encoding requires multiple acquisitions of the same k-space lines to encode the underlying velocities, which can considerably lengthen the total scan time. To reduce scan time, parallel imaging is often applied. In dynamic phase contrast MRI using standard generalized autocalibrating partially parallel acquisitions (GRAPPA), several central k-spaces for autocalibration of the reconstruction (autocalibrating signal lines (ACS)) are typically acquired, separately for each velocity direction and each cardiac timeframe, for calculating the reconstruction weights. To further accelerate data acquisition, we developed two methods, which calculated weights with a substantially reduced number of ACSl lines. The effects on image quality and flow quantification were compared to fully sampled data, standard GRAPPA, and time-interleaved sampling scheme in combination with generalized autocalibrating partially parallel acquisitions (TGRAPPA). The results show that the two proposed methods can clearly improve scan efficiency while maintaining image quality and accuracy of measured flow or myocardial tissue velocities. Compared to TGRAPPA, the proposed methods were more accurate in evaluating flow velocity. In conclusion, the proposed reconstruction strategies are promising for dynamic multidirectionally encoded acquisitions and can easily be implemented using the standard GRAPPA reconstruction algorithm.

Cardiovascular magnetic resonance in patients with pectus excavatum compared with normal controls

PURPOSE

To assess cardiothoracic structure and function in patients with pectus excavatum compared with control subjects using cardiovascular magnetic resonance imaging (CMR).

METHOD

Thirty patients with pectus excavatum deformity (23 men, 7 women, age range: 14-67 years) underwent CMR using 1.5-Tesla scanner (Siemens) and were compared to 25 healthy controls (18 men, 7 women, age range 18-50 years). The CMR protocol included cardiac cine images, pulmonary artery flow quantification, time resolved 3D contrast enhanced MR angiography (CEMRA) and high spatial resolution CEMRA. Chest wall indices including maximum transverse diameter, pectus index (PI), and chest-flatness were measured in all subjects. Left and right ventricular ejection fractions (LVEF, RVEF), ventricular long and short dimensions (LD, SD), mid-ventricle myocardial shortening, pulmonary-systemic circulation time, and pulmonary artery flow were quantified.

RESULTS

In patients with pectus excavatum, the pectus index was 9.3 ± 5.0 versus 2.8 ± 0.4 in controls (P < 0.001). No significant differences between pectus excavatum patients and controls were found in LV ejection fraction, LV myocardial shortening, pulmonary-systemic circulation time or pulmonary flow indices. In pectus excavatum, resting RV ejection fraction was reduced (53.9 ± 9.6 versus 60.5 ± 9.5; P = 0.013), RVSD was reduced (P < 0.05) both at end diastole and systole, RVLD was increased at end diastole (P < 0.05) reflecting geometric distortion of the RV due to sternal compression.

CONCLUSION

Depression of the sternum in pectus excavatum patients distorts RV geometry. Resting RVEF was reduced by 6% of the control value, suggesting that these geometrical changes may influence myocardial performance. Resting LV function, pulmonary circulation times and pulmonary vascular anatomy and perfusion indices were no different to controls.

Breathheld autocalibrated phase-contrast imaging

PURPOSE

To compare generalized autocalibrating partially parallel acquisitions (GRAPPA), modified sensitivity encoding (mSENSE), and SENSE in phase-contrast magnetic resonance imaging (PC-MRI) applications.

MATERIALS AND METHODS

Aliasing of the torso can occur in PC-MRI applications. If the data are further undersampled for parallel imaging, SENSE can be problematic in correctly unaliasing signals due to coil sensitivity maps that do not match that of the aliased volume. Here, a method for estimating coil sensitivities in flow applications is described. Normal volunteers (n = 5) were scanned on a 1.5 T MRI scanner and underwent PC-MRI scans using GRAPPA, mSENSE, SENSE, and conventional PC-MRI acquisitions. Peak velocity and flow through the aorta and pulmonary artery were evaluated.

RESULTS

Bland-Altman statistics for flow in the aorta and pulmonary artery acquired with mSENSE and GRAPPA methods (R = 2 and R = 3 cases) have comparable mean differences to flow acquired with conventional PC-MRI. GRAPPA and mSENSE PC-MRI have more robust measurements than SENSE when there is aliasing artifact caused by insufficient coil sensitivity maps. For peak velocity, there are no considerable differences among the mSENSE, GRAPPA, and SENSE reconstructions and are comparable to conventional PC-MRI.

CONCLUSION

Flow measurements of images reconstructed with autocalibration techniques have comparable agreement with conventional PC-MRI and provide robust measurements in the presence of wraparound.

Use of cardiac output to improve measurement of input function in quantitative dynamic contrast-enhanced MRI

PURPOSE

To validate a new method for converting MR arterial signal intensity versus time curves to arterial input functions (AIFs).

MATERIALS AND METHODS

The method constrains AIF with patient's cardiac output (Q). Monte Carlo simulations of MR renography and tumor perfusion protocols were carried out for comparison with two alternative methods: direct measurement and population-averaged input function. MR renography was performed to assess the method's inter- and intraday reproducibility for renal parameters.

RESULTS

In simulations of tumor perfusion, the precision of the parameters (K(trans) and v(e)) computed using the proposed method was improved by at least a factor of three compared to direct measurement. Similar improvements were obtained in simulations of MR renography. Volunteer study for testing interday reproducibility confirmed the improvement of precision in renal parameters when using the proposed method compared to conventional methods. In another patient study (two injections within one session), the proposed method significantly increased the correlation coefficient (R) between GFR of the two exams (0.92 vs. 0.83) compared to direct measurement.

CONCLUSION

A new method significantly improves the precision of dynamic contrast-enhanced (DCE) parameters. The method may be especially useful for analyzing repeated DCE examinations, such as monitoring tumor therapy or angiotensin converting enzyme-inhibitor renography.

Peak velocity and flow quantification validation for sensitivity-encoded phase-contrast MR imaging

RATIONALE AND OBJECTIVES

Phase-contrast (PC) magnetic resonance imaging (MRI) technique has important clinical applications in blood flow quantification and pressure gradient estimation by velocity measurement. Parallel imaging using sensitivity encoding (SENSE) may substantially reduce scan time. We demonstrate the utility of PC-MRI measurements accelerated by SENSE under clinical conditions.

MATERIALS AND METHODS

Accuracy and repeatability of a SENSE-PC implementation was evaluated by comparison with a commercial PC sequence with five normal volunteers. Twenty-six patients were then scanned with SENSE-PC at reduction factors (R = 1, 2, and 3). Blood flow and peak velocity were measured in the aorta and pulmonary trunk in 16 patients and peak velocity was measured at the coarctation of 10 patients. Quantitative flow, shunt ratio, and peak velocity measurements obtained with different reduction factors were compared using correlation, linear regression, and Bland-Altman statistics. All studies were approved by an Institutional Review Board, and informed consent was acquired from all subjects.

RESULTS

The correlation coefficients for all comparisons were >0.962 and with high statistical significance (P < .01). Linear regression slopes ranged between 0.96 and 1.11 for flow and 0.88 to 1.05 for peak velocity. For flow, the Bland-Altman statistics yielded a total mean difference ranging from -0.02 to 0.05) L/minute with 2 standard of deviation limits ranging from -0.52 to 0.75 L/minute. For peak velocity, the total mean difference ranged from -0.10 to -0.004) milliseconds with 2-SD limits ranging from -0.062 to 0.46 milliseconds. R = 3 to R = 1 comparisons had greater 2-SD limits than R = 2 to R = 1 comparisons.

CONCLUSION

SENSE PC-MRI measurements for flow and pressure gradient estimation were comparable to conventional PC-MRI.

Assessment of the effect of endurance training on left ventricular relaxation with magnetic resonance imaging

The purpose of the study was to assess the effect of endurance training on the early diastolic global and regional left ventricular (LV) relaxation with three magnetic resonance imaging (MRI) techniques. Fourteen subjects were examined with MRI before and after 3-month endurance training. Global early diastolic LV myocardial relaxation was assessed with mitral flow velocity mapping and regional LV early myocardial relaxation with myocardial tagging. LV end-diastolic and end-systolic volumes and mass were assessed with cine Magnetic resonance imaging (MRI). Mitral flow velocity mapping analysis revealed that the time to peak early filling shortened after training (before 112+/-32 ms, after 97+/-21, P<0.05), indicating more rapid global early myocardial relaxation. LV mass increased (97+/-19 g, 105+/-18, P<0.01) and end-systolic volume decreased (47+/-11 mL, 42+/-13, P<0.05). According to myocardial tagging analysis early myocardial relaxation in the septum and in the LV lateral wall increased (P<0.05). Regional tagging analysis showed enhanced myocardial relaxation in the basal septum (P<0.05). Global and regional LV early diastolic relaxation improved and physiological LV hypertrophy was found after the exercise training period for 3 months in healthy sedentary subjects.

MR-based coronary artery blood velocity measurements in patients without coronary artery disease

To evaluate the feasibility of MR-based coronary blood velocity measurements (MRvenc) in patients without coronary artery disease (CAD). Eighty-three patients with angiographically excluded CAD received MRvenc of the proximal segments of both coronary arteries (CAs). Using a retrospectively ECG-gated breath-hold phase-contrast FLASH sequence with high temporal resolution, flow data were technically acquirable in 137/166 (83%) CAs. Quantification and analysis of blood velocities in systole and diastole of both CAs were performed. Biphasic velocity profiles were found in 83/100 CAs. Median systolic and diastolic velocities differed significantly in LCA (19 cm/s, 24 cm/s; P<0.0001) and RCAs (14 cm/s, 16 cm/s; P<0.01). The diastolic/systolic velocity ratio was calculated in LCAs and RCAs with a median of 1.3 and 1.1, respectively. The velocity profiles of the remaining CAs were monophasic (17 CAs) or revealed severe alterations of the physiologic velocity profile with reduced flow undulations and steady velocities (37 CAs). Optimized clinical MRvenc is feasible to quantify blood velocities in the CAs. Potential indications are (1) non-invasive monitoring of patients after aortic valve reconstruction as well as (2) detection of asymptomatic CAD patients.

Dynamic pulmonary perfusion and flow quantification with MR imaging, 3.0T vs. 1.5T: Initial results

PURPOSE

To prospectively evaluate the technical feasibility and relative performance of pulmonary time-resolved MR angiography (MRA) and pulmonary artery (PA) flow quantification at 3.0T vs. 1.5T.

MATERIALS AND METHODS

Time-resolved contrast-enhanced (CE) MRA of the pulmonary circulation, and flow quantification of the main PA (MPA) were performed in 14 consecutive adult healthy volunteers at both 1.5 and 3.0 Tesla with nearly identical sequence parameters. Image quality, signal-to-noise ratio (SNR), and quantitative indices of pulmonary perfusion, flow, and velocity were evaluated and compared at both field strengths.

RESULTS

Time-resolved pulmonary MRA, perfusion, and flow quantification were successfully performed at both magnetic fields. The results of pulmonary perfusion and flow indices were comparable at both magnetic fields, with no statistically significant difference. The SNR values for vascular structures were higher at 3.0T vs. 1.5T (P = 0.001). The SNR values and the definition scores for parenchymal enhancement were significantly lower (P = 0.008 and 0.001, respectively) at 3.0T.

CONCLUSION

Time-resolved pulmonary MRA, perfusion, and flow quantification at 3.0T was feasible, with comparable results to 1.5T. The lower parenchymal enhancement at 3.0T is believed to reflect increased susceptibility effects at higher magnetic fields. Further work is needed to fully exploit the potential of pulmonary perfusion imaging at 3.0T and to address the current limitations.

Coarctation of the aorta: pre and postoperative evaluation with MRI and MR angiography; correlation with echocardiography and surgery

AIMS

To compare MRI and MRA with Doppler-echocardiography (DE) in native and postoperative aortic coarctation, define the best MR protocol for its evaluation, compare MR with surgical findings in native coarctation.

MATERIALS AND METHODS

136 MR studies were performed in 121 patients divided in two groups: Group I, 55 preoperative; group II, 81 postoperative. In group I, all had DE and surgery was performed in 35 cases. In group II, DE was available for comparison in 71 cases. MR study comprised: spin-echo, cine, velocity-encoded cine (VEC) sequences and 3D contrast-enhanced MRA.

RESULTS

In group I, diagnosis of coarctation was made by DE in 33 cases and suspicion of coarctation and/or aortic arch hypoplasia in 18 cases. Aortic arch was not well demonstrated in 3 cases and DE missed one case. There was a close correlation between VEC MRI and Doppler gradient estimates across the coarctation, between MRI aortic arch diameters and surgery but a poor correlation in isthmic measurements. In group II, DE detected a normal isthmic region in 31 out of 35 cases. Postoperative anomalies (recoarctation, aortic arch hypoplasia, kinking, pseudoaneurysm) were not demonstrated with DE in 50% of cases.

CONCLUSIONS

MRI is superior to DE for pre and post-treatment evaluation of aortic coarctation. An optimal MR protocol is proposed. Internal measurement of the narrowing does not correspond to the external aspect of the surgical narrowing.

Magnetic resonance measurement of coronary blood flow

Magnetic resonance (MR) flow measurement in the coronary artery can be achieved with either a breath-hold acquisition or a respiration-triggered acquisition. MR measurements of cardiac output are significantly depressed during breath-holding at deep inspiration, but the advantage is that the breath-hold method requires less scan time. Blood flow in the coronary sinus reflects the global myocardial blood flow because it represents approximately 96% of the total myocardial blood flow of the left ventricle (LV). If blood flow in the coronary sinus is measured with phase-contrast cine magnetic resonance imaging (MRI) and LV myocardial mass is measured with cine MRI, both the total myocardial blood flow and the average coronary blood flow per gram of myocardial mass can be quantified. Coronary flow reserve with volumetric MR flow measurement is measured to be within 4.2-5.0-fold. The noninvasive MR measurement of coronary flow reserve has been shown to be useful in identifying the functional significance of stenoses in the left anterior descending artery. The sensitivity and specificity of MR coronary flow velocity reserve for identifying stenosis of 70% or greater in the left main or left anterior descending artery were 100% and 83%, respectively. The MR quantification of total coronary blood flow and coronary blood flow per gram of myocardial mass seems to be an ideal method for evaluating coronary hemodynamics and may be useful in evaluating endothelial dysfunction of the coronary circulation.

Accelerated dynamic Fourier velocity encoding by exploiting velocity-spatio-temporal correlations

OBJECTIVE

To describe how the information content in a Fourier velocity encoding (FVE) scan can be transformed into a very sparse representation and to develop a method that exploits the compactness of the data to significantly accelerate the acquisition.

MATERIALS AND METHODS

For validation, fully sampled FVE datasets were acquired in phantom and in vivo experiments. Fivefold and eightfold acceleration was simulated by using only one fifth or one eighth of the data for reconstruction in the proposed method based on the k-t BLAST framework. Reconstructed images were compared quantitatively to those from the fully sampled data.

RESULTS

Velocity spectra in the accelerated datasets were comparable to the spectra from fully sampled datasets. The detected peak velocities remained accurate even at eightfold acceleration, and the overall shape of the spectra was well preserved. Slight temporal smoothing was seen in the accelerated datasets.

CONCLUSION

A novel technique for accelerating time-resolved FVE scan is presented. It is possible to accelerate FVE to acquisition speeds comparable to a standard time-resolved phase-contrast scan.

[Pericardium and cardiac valves: value of MRI and Multislice CT]

Color Doppler echocardiography has limitations, particularly in the assessment of valvular regurgitation and pericardial diseases. MRI, with the help of three dimensional morphologic data, dynamic acquisitions with cine techniques and functional evaluation with flow sensitive techniques can be envisioned as a complementary noninvasive procedure able to provide the complete information required for planning therapeutic options. Qualitative as well as accurate and reproducible quantitative information (volume measurements, cardiac function and flow velocity profiles) are unique for the evaluation of the severity of valve or pericardial diseases. Multislice CT is unique in precisely demonstrating valvular and pericardial calcifications. This article reviews both imaging techniques used in assessing valvular and pericardial disease and discusses the advantages and limitations of these techniques in current clinical applications.

Cardiovascular shunts: MR imaging evaluation

Magnetic resonance (MR) imaging has become an important tool for the accurate and noninvasive assessment of congenital heart disease. Because more precise delineation of anatomy and evaluation of function can be obtained with MR imaging than with either echocardiography or angiography, MR imaging is frequently used to evaluate cardiovascular shunt lesions. It is essential that imaging specialists be able to recognize the MR imaging features of various kinds of shunts, including supracristal ventricular septal defect, atrioventricular septal defect, and partial anomalous pulmonary venous connection. MR imaging is particularly useful for evaluating shunt severity, which can be expressed quantitatively as the ratio of pulmonary flow to systemic flow. This ratio can be estimated accurately with the use of either volumetric cine MR imaging or velocity-encoded cine MR imaging.

Assessment of valve disease: qualitative and quantitative

Evaluation of valve disease has changed significantly with the development of color Doppler echocardiography. Nevertheless, this technique has limitations, particularly in the assessment of valvular regurgitation. MR imaging, with its ability to provide three-dimensional morphologic data, dynamic cine information, and functional evaluation with flow-sensitive techniques, can be envisioned as a complementary noninvasive modality, able to provide the complete information required for planning therapeutic options. With MR imaging, qualitative as well as accurate and reproducible quantitative information such as volume measurements, cardiac function, and flow velocity profiles are unique for the evaluation of the severity of valve disease. This article reviews the different MR imaging techniques used in assessing valvular heart disease and discusses the advantages and limitations of these techniques in current clinical applications in comparison with classical imaging methods.

Assessment of diastolic function by cardiovascular magnetic resonance

BACKGROUND

The assessment of diastolic heart function has been hampered by multiple difficulties. Cardiovascular magnetic resonance (CMR) is a new, noninvasive technique to study cardiac function.

METHODS

The literature on CMR for the analysis of diastolic function and its clinical applications is extensively reviewed.

RESULTS

Analysis of ventricular filling velocity and volume flow, volumetric assessment of ventricular chamber volume, analysis of 3-dimensional myocardial strains, and assessment of myocardial energy content are numerous validated applications of CMR. With the advent of real-time imaging and automated analysis of myocardial strains, CMR tagging is a promising method to assess regional diastolic function. Today, many CMR techniques are leaving the experimental or developmental stage rapidly and becoming clinically available for the evaluation of diastolic function in heart disease.

CONCLUSIONS

CMR is emerging as a highly accurate and reproducible noninvasive 3-dimensional technique for the assessment of diastolic function.

Quantification of flow dynamics in congenital heart disease: applications of velocity-encoded cine MR imaging

Velocity-encoded cine (VEC) magnetic resonance (MR) imaging is a valuable technique for quantitative assessment of flow dynamics in congenital heart disease (CHD). VEC MR imaging has a variety of clinical applications, including the measurement of collateral flow and pressure gradients in coarctation of the aorta, differentiation of blood flow in the left and right pulmonary arteries, quantification of shunts, and evaluation of valvular regurgitation and stenosis. After surgical repair of CHD, VEC MR imaging can be used to monitor conduit blood flow, stenosis, and flow dynamics. There are some pitfalls that can occur in VEC MR imaging. These include potential underestimation of velocity and flow, aliasing, inadequate depiction of very small vessels, and possible errors in pressure gradient measurements. Nevertheless, VEC MR imaging is a valuable tool for preoperative planning and postoperative monitoring in patients with CHD.

Effect of breath holding on blood flow measurement using fast velocity encoded cine MRI

Breath-hold MR measurement of cardiac output was compared with results from respiratory triggered MR acquisitions, since flow measurement during breath-holding may be different from physiological blood flow. Cardiac output during large lung volume breath-holding (4.47 +/- 0.63 l/min in the aorta and 4.53 +/- 0.59 l/min in the pulmonary artery) was significantly lower than that measured during normal breathing (6.09 +/- 0.49 l/min and 6.48 +/- 0.67 l/min, P < 0.01). In contrast, no significant difference was found between measurements conducted with small lung volume breath-holding (5.87 +/- 0.53 l/min and 6.41 +/- 0.75 l/min) and normal breathing. In conclusion, breath-hold MR flow measurement using small lung volume by shallow inspiration can provide a blood flow quantification that is close to physiological blood flow. Magn Reson Med 45:346-348, 2001.

Identification of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation using MRI

Pulmonary vein stenosis is one of the frequent complications after radiofrequency ablation for atrial fibrillation. MRI plays an important role in depicting the pathoanatomic structure of the pulmonary veins, and measuring the blood flow velocity in the pulmonary veins before and after therapy, and is superior to transesophageal echocardiography for this purpose.

Cardiac imaging

The emergence of noninvasive imaging techniques for the definitive diagnosis and monitoring of cardiovascular disease has greatly altered cardiac imaging in the past 25 years. The practice of cardiac imaging in 1975 was centered on conventional radiography and angiography, but, in the past 2 decades, noninvasive techniques have substantially replaced catheterization and angiography. The reliance on echocardiography for the evaluation of many cardiac diseases had a profoundly negative influence on the role of the radiologist in cardiac imaging, since the exercise of this modality has been a nearly exclusive province of the cardiologist. However, in the past decade, magnetic resonance imaging has been gradually assuming more importance in cardiovascular diagnosis; with this increase in importance, the role of the radiologist has been reactivated. In 1975, fellowship training in cardiac imaging was frequently combined with training in angiography. Now, training may be more effective by combining cardiac and pulmonary imaging in a thoracic imaging fellowship, but cross-training with an associated subspeciality will be influenced by priorities and personnel in various departments.

Detection and quantification of valvular heart disease with dynamic cardiac MR imaging

Magnetic resonance (MR) imaging is rapidly gaining acceptance as an accurate, reproducible, noninvasive method for optimal assessment of structural and functional parameters in patients with valvular heart disease. The severity of valvular regurgitation can be evaluated with cine gradient-echo MR imaging, which allows measurement of the area of the signal void corresponding to the abnormal flow jet. Alternatively, this modality can be used to obtain ventricular volumetric measurements and calculate the regurgitant fraction, or velocity-encoded cine (VEC) MR imaging can be used to quantify regurgitant blood flow. The severity of valvular stenosis can be determined by evaluating the flow jet and associated findings with either modality or by using VEC MR imaging to calculate the transvalvular pressure gradient and valve area. Dynamic MR imaging allows accurate assessment of ventricular function and comprehensive evaluation of pathophysiologic changes. In addition, good interstudy reproducibility suggests a role for VEC MR imaging in assessing the effects of therapeutic intervention and monitoring regurgitant fraction, thereby helping in surgical planning and the prevention of ventricular dysfunction. With greater cost-effectiveness and the increasing availability of new hardware and more advanced techniques, MR imaging will become a routine procedure in valvular heart disease.

Reduction of electromagnetic interference from a commercially available MR-compatible flow simulator

Electromagnetic interference (EMI) associated with the electronics of a commercially available computer controlled flow simulator substantially decreases the quality of the MR image. The effect of a custom-built radiofrequency shield on its spectral emission, and the corresponding signal-to-noise ratio measured for the image of a standard phantom, were determined. The results demonstrate the elimination of EMI and a significant improvement in image quality.

Right ventricular volumes and ejection fraction with fast cine MR imaging in breath-hold technique: applicability, normal values from 52 volunteers, and evaluation of 325 adult cardiac patients

Our goal was to establish right ventricular (RV) volume and ejection fraction (EF) values in normal volunteers with fast magnetic resonance (MR) imaging using a breath-hold technique, to assess the frequency and severity of RVEF abnormality in cardiac patients and to compare RV with left ventricular (LV) data. We performed simultaneously derived RV and LV fast cine measurements in 52 normals and 325 patients with coronary artery disease (CAD), acquired valvular disease (VD), cardiomyopathy (CM), or congenital heart disease (CHD). RVEF was reduced in 31% (102) of all patients, in 50% dilated CM, 39% CHD, 34% CAD, and 22% acquired VD patients. Solitary abnormally low RVEF was found in only 15/325 (5%) of all patients, whereas combined with LVEF deterioration in 87/172 (51%) patients. RVEF reduction was mild in 64%, moderate in 25%, and severe in 11%. Although RVEF correlated significantly (r = 0.55, P < 0.001) with LVEF, the predictive value of LVEF for RVEF was low. We conclude that RV volumes can be routinely assessed with fast MRI and should be performed in addition to LV evaluation in CHD, in right-sided VD, and in all patients with an abnormal LVEF.J. Magn. Reson. Imaging 1999; 10:908-918.

Morphologic and functional evaluation of congenital heart disease by magnetic resonance imaging

Magnetic resonance imaging (MRI) has evolved sufficiently to be recognized as a useful complementary noninvasive method to echocardiography in the evaluation of congenital heart disease (CHD). In some cases, MRI is superior to other imaging modalities, particularly in the evaluation of thoracic aortic anomalies and in defining the anatomy of central pulmonary arteries; it is also the procedure of choice in the postoperative follow-up of patients with CHD. Recent technological advances permit not only morphological evaluation (provided by spin-echo and MR angiographic techniques) but functional and flow information (provided by fast cine-GE and velocity-encoded sequences), causing it to be recognized by pediatric cardiologists and cardiac surgeons as an unavoidable technique for pre- and postoperative evaluation of some CHD. This review describes the various techniques used in the evaluation of CHD with emphasis on recent developments as well as recognized clinical applications. J. Magn. Reson. Imaging 1999;10:639-655.

MR measurement of coronary blood flow

The functional significance of coronary arterial stenosis can be evaluated by measuring the pharmacological flow reserve. Magnetic resonance (MR) imaging has a unique potential for noninvasive measurement of coronary blood flow and flow reserve in the native coronary artery and bypass graft. Restenosis after coronary balloon angioplasty and stenting in the left anterior descending artery can be detected noninvasively with serial MR measurements of the coronary flow reserve. Further refinement of the MR pulse sequences to improve spatial and temporal resolutions may permit accurate quantification of blood flow volume and flow reserve in all major coronary arterial branches. MR assessments of blood flow volume and flow pattern allow noninvasive detection of significant stenosis in the coronary artery bypass graft as well. By integrating MR blood flow measurement in the coronary sinus and cine MR assessment of left ventricular myocardial mass, altered myocardial micro-circulation in patients with diffuse myocardial diseases, such as hypertrophic cardiomyopathy and cardiac transplant, has been documented. J. Magn. Reson. Imaging 1999;10:728-733.

Complex flow patterns in the great vessels: a review

The article reviews the applications of magnetic resonance velocity mapping based on phase shifts in the protons to quantify blood flow velocity and blood flow volume. The method can be used to study normal physiology of blood flow in the aorta and its major branches, including forward and backward flow, to measure the aortic valve function in aortic valvular disease, stenosis and regurgitation, as well as pulmonary artery flow velocities in pulmonic insufficiency and regurgitation. Superior vena cava flows, pulmonary vein flows, left-to-right shunts, atrial and ventricular pulmonary conduit flows can also be measured. Two- and three-directional velocity mapping is reviewed and can be used to study three- or four-D flows in the aorta and the major arteries in great detail.

Fast magnetic resonance imaging of the heart

Fast MR imaging techniques have multiple applications for evaluation of cardiac disease. Cine MRI and MR tagging have been shown to be highly accurate and reproducible in evaluating regional and global myocardial function. Segmented k-space cine MRI and echo-planar imaging (EPI) can considerably improve time efficiency and thereby the clinical utility of these techniques. Double IR fast spin-echo sequences enable breath-hold acquisition of T2 weighted MRI with good suppression of the blood signal. Myocardial perfusion can be assessed with fast dynamic MRI after administration of contrast media. Multi-shot EPI improves temporal resolution and also provides full coverage of the left ventricle. Substantial progress has been made in respiratory gated 3D coronary artery MR angiography with navigator echoes. The newer approaches for coronary arterial imaging including breath-hold three-dimensional segmented EPI and high resolution spiral MRI may further improve clinical usefulness of coronary MR angiography. Assessment of coronary blood flow and flow reserve with phase contrast MRI has the potential for the non-invasive evaluating of the presence and significance of stenosis in the native coronary artery and bypass grafts. Fast cardiac MRI may emerge as a cost effective modality for comprehensive assessments of both cardiac morphology, function, blood flow and perfusion.

Automated measurement of volume flow in the ascending aorta using MR velocity maps: evaluation of inter- and intraobserver variability in healthy volunteers

PURPOSE

An automated contour detection algorithm was developed for the objective and reproducible quantitative analysis of velocity-encoded MR studies of the ascending aorta.

METHOD

The only user interaction required is the manual definition of a center point inside the cross-section of the aorta in one of the available images. The automated contour detection algorithm detects an initial model contour in this image and subsequently corrects for motion and deformation of the aortic cross-section in each of the acquired images over the complete cardiac cycle using dynamic programming techniques. Integrating the flow velocity values for each pixel within the detected contour results in an instantaneous flow value. Next, by integrating the instantaneous flow values for each acquired phase over the complete cardiac cycle, left ventricular stroke volume measurement could be obtained. The results of the automated method were compared with results derived from manually traced contours in MR studies from 11 healthy volunteers.

RESULTS

An excellent agreement in stroke volume measurements was observed: signed difference 0.61+/-1.15%. Inter- and intraobserver variabilities were <2% for both manual and automated image analysis methods. Manual tracing of contours required on the order of 10 min; the analysis time for automated contour detection was <6 s/study.

CONCLUSION

The present contour detection allows fast and reliable left ventricular stroke volume measurements from aortic flow studies using velocity-encoded MR studies in healthy volunteers. Further study is required to assess the accuracy and reproducibility of the algorithm in patients with aortic and aortic valve disease.

Congenital heart disease: measuring physiology with MRI

Cine MRI and VEC MRI can be used to quantitate the physiology of the heart and great vessels in patients with CHD. This information can be a valuable adjunct to anatomical imaging for preoperative planning as well as postoperative monitoring. Some important clinical applications of quantitative cardiovascular functional MRI include measurement of ventricular masses, stroke volumes, and ejection fractions; estimation of shunts and valvular regurgitation; assessment of collateral blood flow and pressure gradients in aortic coarctation; and postsurgical evaluation of conduit blood flow and pressure gradients.

Anatomical variation of cerebral venous drainage: the theoretical effect on jugular bulb blood samples

Recent studies have demonstrated significant variation in bilateral jugular venous oxygen saturation measurements which may be of clinical significance. We have therefore measured variations in normal dural sinus venous drainage to assess the possible effects of normal anatomical variations on measured jugular venous oxygen saturation. Normal volunteers (n = 25) were imaged using magnetic resonance venography to demonstrate variations in venous anatomy. Flow was measured in the superior sagittal sinus and bilaterally in the transverse sinus, sigmoid sinus proximal to the jugular bulb and proximal jugular vein using phase difference magnetic resonance imaging. Examination of magnetic resonance venogram images showed considerable variability in the symmetry of transverse sinus flow. Complete absence of one transverse sinus was seen in four cases and significant asymmetry in the size of the transverse sinuses was present in 13. Quantitative flow studies demonstrated that the ratio of superior sagittal sinus to combined jugular bulb flow showed remarkably little variation (0.46 +/- 0.06). Measurements of transverse sinus flow showed significant asymmetry (< 40% of superior sagittal sinus flow in one transverse sinus) in 21 of 25 volunteers. The effect of the observed asymmetry on jugular venous oxygen saturation was modelled based on the assumption of either a supratentorial or infratentorial lesion. This model predicted significant asymmetry in jugular venous oxygen saturation measurements (> 10%) in 65% of cases with a supratentorial lesion which is in close agreement with clinical observations. This study suggests that normal variations in venous drainage may account for observed asymmetry in jugular venous oxygen saturation measurements.

Integrated MR imaging approach to valvular heart disease

With development of cine and velocity encoded magnetic resonance imaging, it is now feasible to detect and quantify aortic and mitral stenosis and regurgitation accurately. In addition, magnetic resonance imaging has the capabilities to assess simultaneously left and right ventricular mass, volumes, and function precisely. The high accuracy and reproducibility of magnetic resonance imaging in quantification of regurgitation and ventricular function has the potential to provide improved monitoring of therapy and optimal timing of surgery in patients with valvular dysfunction. In comparison to echocardiography and angiography, some current limitations of magnetic resonance imaging to an integrated approach of valvular heart disease exist, which may be removed with future refinement of magnetic resonance imaging technology for cardiovascular imaging.

Measurement of renal vein blood flow in rats by high-field magnetic resonance

The aim of the present study was to examine whether magnetic resonance imaging (MRI) based method for non-invasive in vivo measurement of vein blood flow in rats could be used to estimate renal blood flow (RBF). Measurements were performed using a high-field (7 Tesla) MRI scanner with a short echo time phase contrast velocity measurement pulse sequence. The method was evaluated in vitro by flow measurements in an acrylic pipe and in vivo by recording left renal vein blood flow in normal and unilaterally nephrectomized rats. In a subset of animals RBF was measured by a direct method using 14C-tetraethylammoniumbromide. In vitro a high accuracy was found between applied and MRI measured flow rates in the range from 0.5 to 33 ml/min (r = 0.997; P < 0.001). In vivo the MRI measured left renal vein blood flow was 70% higher in unilaterally nephrectomized animals compared to control animals (3.4 +/- 0.4 ml/min/ 100 g body wt vs. 2.0 +/- 0.1 ml/min/100 g body wt, P < 0.001). Direct measurements of RBF revealed comparable values (3.4 +/- 0.3 ml/min/100 g body wt vs. 2.3 +/- 0.4 ml/min/100 g body wt, P = 0.05). In addition, the left kidney volume was recorded by MRI with an increase amounting to 40% (1.18 +/- 0.05 ml vs. 0.84 +/- 0.02 ml; P < 0.001) in the nephrectomized group compared to controls. Finally, a positive correlation was seen between left renal vein blood flow and MRI measured renal volume (r = 0.91; P < 0.001). In summary, MRI is a non-invasive tool by which measurement of renal vein blood flow can be performed, and it is concluded that MRI-based renal vein flow measurements can be used to estimate RBF in small rodents.