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Phase-contrast magnetic resonance imaging to assess renal perfusion: a systematic review and statement paper. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:3-21. [PMID: 31422518 PMCID: PMC7210220 DOI: 10.1007/s10334-019-00772-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/09/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023]
Abstract
Objective Phase-contrast magnetic resonance imaging (PC-MRI) is a non-invasive method used to compute blood flow velocity and volume. This systematic review aims to discuss the current status of renal PC-MRI and provide practical recommendations which could inform future clinical studies and its adoption in clinical practice. Methodology A comprehensive search of all the PC-MRI studies in human healthy subjects or patients related to the kidneys was performed. Results A total of 39 studies were included in which PC-MRI was used to measure renal blood flow (RBF) alongside other derivative hemodynamic parameters. PC-MRI generally showed good correlation with gold standard methods of RBF measurement, both in vitro and in vivo, and good reproducibility. Despite PC-MRI not being routinely used in clinical practice, there are several clinical studies showing its potential to support diagnosis and monitoring of renal diseases, in particular renovascular disease, chronic kidney disease and autosomal dominant polycystic kidney disease. Discussion Renal PC-MRI shows promise as a non-invasive technique to reliably measure RBF, both in healthy volunteers and in patients with renal disease. Future multicentric studies are needed to provide definitive normative ranges and to demonstrate the clinical potential of PC-MRI, likely as part of a multi-parametric renal MRI protocol. Electronic supplementary material The online version of this article (10.1007/s10334-019-00772-0) contains supplementary material, which is available to authorized users.
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Babin D, Devos D, Pižurica A, Westenberg J, Vansteenkiste E, Philips W. Robust segmentation methods with an application to aortic pulse wave velocity calculation. Comput Med Imaging Graph 2014; 38:179-89. [PMID: 24405817 DOI: 10.1016/j.compmedimag.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 11/06/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
Aortic stiffness has proven to be an important diagnostic and prognostic factor of many cardiovascular diseases, as well as an estimate of overall cardiovascular health. Pulse wave velocity (PWV) represents a good measure of the aortic stiffness, while the aortic distensibility is used as an aortic elasticity index. Obtaining the PWV and the aortic distensibility from magnetic resonance imaging (MRI) data requires diverse segmentation tasks, namely the extraction of the aortic center line and the segmentation of aortic regions, combined with signal processing methods for the analysis of the pulse wave. In our study non-contrasted MRI images of abdomen were used in healthy volunteers (22 data sets) for the sake of non-invasive analysis and contrasted magnetic resonance (MR) images were used for the aortic examination of Marfan syndrome patients (8 data sets). In this research we present a novel robust segmentation technique for the PWV and aortic distensibility calculation as a complete image processing toolbox. We introduce a novel graph-based method for the centerline extraction of a thoraco-abdominal aorta for the length calculation from 3-D MRI data, robust to artifacts and noise. Moreover, we design a new projection-based segmentation method for transverse aortic region delineation in cardiac magnetic resonance (CMR) images which is robust to high presence of artifacts. Finally, we propose a novel method for analysis of velocity curves in order to obtain pulse wave propagation times. In order to validate the proposed method we compare the obtained results with manually determined aortic centerlines and a region segmentation by an expert, while the results of the PWV measurement were compared to a validated software (LUMC, Leiden, the Netherlands). The obtained results show high correctness and effectiveness of our method for the aortic PWV and distensibility calculation.
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Affiliation(s)
- Danilo Babin
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - Daniel Devos
- Department of Radiology, Cardiovascular MR & CT, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Aleksandra Pižurica
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - Jos Westenberg
- Department of Radiology, LUMC, Leiden University Medical Center, Albinusedreef 2, 2333 ZA Leiden, The Netherlands.
| | - Ewout Vansteenkiste
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - Wilfried Philips
- Department of Telecommunications and Information Processing - TELIN-IPI-iMinds, Faculty of Sciences, Ghent University, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
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Zhang W, Qian Y, Lin J, Lv P, Karunanithi K, Zeng M. Hemodynamic analysis of renal artery stenosis using computational fluid dynamics technology based on unenhanced steady-state free precession magnetic resonance angiography: preliminary results. Int J Cardiovasc Imaging 2013; 30:367-75. [DOI: 10.1007/s10554-013-0345-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/01/2013] [Indexed: 12/01/2022]
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Quantitative comparison of the dynamic flow waveform changes in 12 ruptured and 29 unruptured ICA-ophthalmic artery aneurysms. Neuroradiology 2013; 55:313-20. [PMID: 23443738 PMCID: PMC3582813 DOI: 10.1007/s00234-012-1108-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/17/2012] [Indexed: 11/30/2022]
Abstract
Introduction Studies have reported a correlation between blood flow dynamics in the cardiac cycle and vascular diseases, but research to analyze the dynamic changes of flow in cerebral aneurysms is limited. This quantitative study investigates the temporal changes in flow during a cardiac cycle (flow waveform) in different regions of aneurysms and their association with aneurysm rupture. Methods Twelve ruptured and 29 unruptured aneurysms from the internal carotid artery–ophthalmic artery segment were studied. Patient-specific aneurysm data were implemented to simulate blood flow. The temporal flow changes at different regions of the aneurysm were recorded to compare the flow waveforms. Results In more than 60 % of the cases, peak flow in the aneurysm sac occurred after peak flow in the artery. Flow rate varied among cases and no correlation with rupture, aneurysm flow rate, and aneurysm size was found. Higher pulsatility within aneurysm sacs was found when comparing with the parent artery (P < 0.001). Pulsatility was high throughout ruptured aneurysms, but increased from neck to dome in unruptured ones (P = 0.021). Significant changes between inflow and outflow flow profile were found in unruptured aneurysms (P = 0.023), but not in ruptured aneurysms. Conclusion Quantitative analysis which considers temporal blood flow changes appears to provide additional information which is not apparent from aneurysmal flow at a single time point (i.e., peak of systole). By considering the flow waveform throughout the cardiac cycle, statistically significant differences were found between ruptured and unruptured cases — for flow profile, pulsatility and timing of peak flow.
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Patti J, Viñuela F, Chien A. Distinct trends of pulsatility found at the necks of ruptured and unruptured aneurysms. J Neurointerv Surg 2013; 6:103-7. [DOI: 10.1136/neurintsurg-2013-010660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Larsson M, Persson A, Eriksson P, Kihlberg J, Smedby Ö. Renal artery stenosis: Extracting quantitative parameters with a mathematical model fitted to magnetic resonance blood flow data. J Magn Reson Imaging 2007; 27:140-7. [DOI: 10.1002/jmri.21232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Michaely HJ, Schoenberg SO, Rieger JR, Reiser MF. MR Angiography in Patients with Renal Disease. Magn Reson Imaging Clin N Am 2005; 13:131-51, vi. [PMID: 15760760 DOI: 10.1016/j.mric.2004.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Henrik J Michaely
- Department of Clinical Radiology, University Hospitals, Ludwig Maximilians University-Munich, Grosshadern Marchioninistrasse 15, Munich 81377, Germany.
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Yim PJ, Cebral JR, Weaver A, Lutz RJ, Soto O, Vasbinder GBC, Ho VB, Choyke PL. Estimation of the differential pressure at renal artery stenoses. Magn Reson Med 2004; 51:969-77. [PMID: 15122679 DOI: 10.1002/mrm.20078] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Atherosclerotic disease of the renal artery can lead to reduction in arterial caliber and ultimately to conditions including renovascular hypertension. Renal artery stenosis is conventionally assessed, using angiography, according to the severity of the stenosis. However, the severity of a stenosis is not a reliable indicator of functional significance, or associated differential pressure, of a stenosis. A methodology is proposed for estimation of the renal artery differential pressure (RADP) from MR imaging. Realistic computational fluid dynamics (CFD) models are constructed from MR angiography (MRA) and phase-contrast (PC) MR. The CFD model is constructed in a semiautomated manner from the MR images using the Isosurface Deformable Model (IDM) for surface reconstruction and a Marching Front algorithm for construction of the volumetric CFD mesh. Validation of RADP estimation was performed in a realistic physical flow-through model. Under steady flow, the CFD estimate of the differential pressure across a stenosis in the physical flow-through model differed by an average of 5.5 mmHg from transducer measurements of the pressure differential, for differential pressures less than 60 mmHg. These results demonstrate that accurate estimates of differential pressure at stenoses may be possible based only on structural and flow images.
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Affiliation(s)
- Peter J Yim
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA.
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Vlaardingerbroek MT, den Boer JA. Contrast and Signal-to-Noise Ratio. Magn Reson Imaging 2003. [DOI: 10.1007/978-3-662-05252-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Renal MRA. J Vasc Interv Radiol 2002. [DOI: 10.1016/s1051-0443(02)70024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Westenberg JJ, van der Geest RJ, Wasser MN, Doornbos J, Pattynama PM, de Roos A, Vanderschoot J, Reiber JH. Stenosis quantification from post-stenotic signal loss in phase-contrast MRA datasets of flow phantoms and renal arteries. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1999; 15:483-93. [PMID: 10768743 DOI: 10.1023/a:1006329032742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this study a semi-automated and observer-independent algorithm for quantifying post-stenotic signal loss (PSL) in 3D phase-contrast (PC) magnetic resonance angiography (MRA) of patients with renal artery stenosis is presented. This algorithm was developed on MRA datasets of stenotic phantoms, which were included in a flow circuit with stationary flows. The length and the severity of the PSL (incorporating both length and degree of PSL) in the maximum intensity projections (MIPs) of MRA datasets were proposed for quantifying stenoses. The algorithm was tested in renal arteries of ten patients with renal artery stenosis and seven healthy volunteers. Digital subtraction angiography (DSA) was performed in the patients and served as the gold standard. Stenosis severity showed better correlation with the severity of the PSL than with the length, both for in vitro as in vivo. Spearman correlation coefficients (rS) showed statistically significant correlations between the severity of the PSL and parameters determined by DSA, i.e. percent diameter stenosis (rS = 0.90). The length of the PSL showed no correlation with the diameter stenosis (rS = 0.37).
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Affiliation(s)
- J J Westenberg
- Division of Image Processing, Leiden University Medical Center, The Netherlands
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Schoenberg SO, Essig M, Bock M, Hawighorst H, Sharafuddin M, Knopp MV. Comprehensive MR evaluation of renovascular disease in five breath holds. J Magn Reson Imaging 1999; 10:347-56. [PMID: 10508296 DOI: 10.1002/(sici)1522-2586(199909)10:3<347::aid-jmri17>3.0.co;2-a] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To detect a renal artery stenosis and assess its hemodynamic and functional significance in five breath holds. In a single MR exam, T1 weighted FLASH and T2 weighted fast spin echo techniques are used to assess renal morphology, multiphase 3D gadolinium (Gd) MRA to evaluate the renal arteries, and a segmented EPI cine phase-contrast technique to measure renal artery blood flow. A standardized image analysis is performed to assess kidney size, corticomedullar differentiation (CMD), parenchymal enhancement, the degree of renal artery stenosis, abnormalities in blood flow pattern, and any associated abdominal vascular disease. Multiphase 3D-Gd-MRA accurately assesses atherosclerotic renal artery disease particularly in the presence of an associated aortic aneurysm. Delayed parenchymal enhancement, loss of CMD, and decrease in kidney size can be detected. In combination with decreased systolic velocity components, the diagnosis of a hemodynamically and functionally significant stenosis can be made. High-resolution single-phase 3D-Gd-MRA is preferable for evaluation of fibromuscular dysplasia or hypoplastic vessels. The combination of different breath hold techniques in a single, standardized MR exam allows to detect the hemodynamic and functional significance of a renal artery stenosis.
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Affiliation(s)
- S O Schoenberg
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany.
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Motion and Flow. Magn Reson Imaging 1999. [DOI: 10.1007/978-3-662-03800-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Westenberg JJ, van der Geest RJ, Wasser MN, Doornbos J, Pattynama PM, de Roos A, Vanderschoot J, Reiber JH. Objective stenosis quantification from post-stenotic signal loss in phase-contrast magnetic resonance angiographic datasets of flow phantoms and renal arteries. Magn Reson Imaging 1998; 16:249-60. [PMID: 9621966 DOI: 10.1016/s0730-725x(97)00298-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study a semi-automated and observer-independent algorithm for quantifying post-stenotic signal loss (PSL) in three-dimensional phase-contrast (PC) magnetic resonance angiography (MRA) of patients with renal artery stenosis is presented. This algorithm was developed on MRA datasets of stenotic phantoms, included in a flow circuit with stationary flows. The length and the severity of the PSL (incorporating both the length and the degree of PSL) in the MRA datasets were proposed for quantifying the stenoses. The algorithm was tested in renal arteries; ten patients with renal artery stenosis and seven healthy volunteers were investigated. Digital subtraction angiography was performed in the patients and served as the gold standard. Stenosis severity showed better correlation with the severity of the PSL than with the length, both for in vitro and in vivo measurements. Spearman correlation coefficients (rs) showed statistically significant correlations between the severity of the PSL and parameters determined by digital subtraction angiography, i.e., percent diameter stenosis (rs = 0.90). The length of the PSL showed no correlation with the diameter stenosis (rs = 0.37). In conclusion, this study presents a semi-automated and observer-independent way of quantifying signal loss, and the severity of the PSL is proposed for quantifying stenoses, rather than the length of PSL.
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Affiliation(s)
- J J Westenberg
- Division of Image Processing, Leiden University Medical Centre, The Netherlands
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