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Noninvasive 4D pressure difference mapping derived from 4D flow MRI in patients with repaired aortic coarctation: comparison with young healthy volunteers

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Abstract

To assess spatial and temporal pressure characteristics in patients with repaired aortic coarctation compared to young healthy volunteers using time-resolved velocity-encoded three-dimensional phase-contrast magnetic resonance imaging (4D flow MRI) and derived 4D pressure difference maps. After in vitro validation against invasive catheterization as gold standard, 4D flow MRI of the thoracic aorta was performed at 1.5T in 13 consecutive patients after aortic coarctation repair without recoarctation and 13 healthy volunteers. Using in-house developed processing software, 4D pressure difference maps were computed based on the Navier–Stokes equation. Pressure difference amplitudes, maximum slope of pressure amplitudes and spatial pressure range at mid systole were retrospectively measured by three readers, and twice by one reader to assess inter- and intraobserver agreement. In vitro, pressure differences derived from 4D flow MRI showed excellent agreement to invasive catheter measurements. In vivo, pressure difference amplitudes, maximum slope of pressure difference amplitudes and spatial pressure range at mid systole were significantly increased in patients compared to volunteers in the aortic arch, the proximal descending and the distal descending thoracic aorta (p < 0.05). Greatest differences occurred in the proximal descending aorta with values of the three parameters for patients versus volunteers being 19.7 ± 7.5 versus 10.0 ± 2.0 (p < 0.001), 10.9 ± 10.4 versus 1.9 ± 0.4 (p = 0.002), and 8.7 ± 6.3 versus 1.6 ± 0.9 (p < 0.001). Inter- and intraobserver agreements were excellent (p < 0.001). Noninvasive 4D pressure difference mapping derived from 4D flow MRI enables detection of altered intraluminal aortic pressures and showed significant spatial and temporal changes in patients with repaired aortic coarctation.

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Acknowledgments

This work was supported by the German Research Foundation (DFG) within the ‘‘Research training group 1126: Intelligent Surgery—Development of new computer-based methods for the future workplace in surgery’’ and the “DFG Grant UN 306/1-1”.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Fabian Rengier, Hendrik von Tengg-Kobligk, Julia Ley-Zaporozhan, Hans-Ulrich Kauczor & Sebastian Ley

  2. Department of Radiology, German Cancer Research Center (dkfz) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Fabian Rengier

  3. Department of Informatics, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology (KIT), Adenauerring 2, 76131, Karlsruhe, Germany

    Michael Delles, Yoo-Jin Azad, Rüdiger Dillmann & Roland Unterhinninghofen

  4. Department of Paediatric Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

    Joachim Eichhorn

  5. Institute for Diagnostic, Interventional and Paediatric Radiology, University Hospital Bern, Inselspital, Freiburgstr. 10, 3010, Bern, Switzerland

    Hendrik von Tengg-Kobligk

  6. Institute of Clinical Radiology, University Hospital Munich, Lindwurmstrasse 4, 80338, Munich, Germany

    Julia Ley-Zaporozhan

  7. Diagnostic and Interventional Radiology, Chirurgische Klinik Dr. Rinecker, Am Isarkanal 30, 81379, Munich, Germany

    Sebastian Ley

  8. Children’s Hospital, Klinikum Leverkusen, Am Gesundheitspark 11, 51375, Leverkusen, Germany

    Joachim Eichhorn

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  1. Fabian Rengier
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  2. Michael Delles
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  8. Hans-Ulrich Kauczor
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  9. Roland Unterhinninghofen
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Correspondence to Fabian Rengier.

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Rengier, F., Delles, M., Eichhorn, J. et al. Noninvasive 4D pressure difference mapping derived from 4D flow MRI in patients with repaired aortic coarctation: comparison with young healthy volunteers. Int J Cardiovasc Imaging 31, 823–830 (2015). https://doi.org/10.1007/s10554-015-0604-3

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  • DOI: https://doi.org/10.1007/s10554-015-0604-3

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