Abstract
Imaging of the aorta is mainly done using MR and CT as outlined in other chapters. Both techniques have the advantage of being able to depict intraluminal, intramural, and surrounding pathologies with high spatial resolution and excellent tissue contrast. However, describing the function of the aorta itself as well as the interplay between blood flow and aortic remodeling is challenging. With the advent of a novel MR technique, called 4D flow, new insights into aortic pathophysiology are possible (Markl, Kilner, Ebbers, J Cardiovasc Magn Reson.13:7, 2011).
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References
Markl M, Kilner PJ, Ebbers T. Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:7.
Myerson SG. Heart valve disease: investigation by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:7.
Strecker C, Harloff A, Wallis W, Markl M. Flow-sensitive 4D MRI of the thoracic aorta: comparison of image quality, quantitative flow, and wall parameters at 1.5 T and 3 T. J Magn Reson Imaging. 2012;36:1097–103.
Bock J, Frydrychowicz A, Stalder AF, et al. 4D phase contrast MRI at 3 T: effect of standard and blood-pool contrast agents on SNR, PC-MRA, and blood flow visualization. Magn Reson Med. 2010;63:330–8.
Markl M, Schnell S, Barker AJ. 4D flow imaging: current status to future clinical applications. Curr Cardiol Rep. 2014;16:481.
Lorenz R, Bock J, Barker AJ, et al. 4D flow magnetic resonance imaging in bicuspid aortic valve disease demonstrates altered distribution of aortic blood flow helicity. Magn Reson Med. 2014;71:1542–53.
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.
Kilner PJ, Yang GZ, Wilkes AJ, Mohiaddin RH, Firmin DN, Yacoub MH. Asymmetric redirection of flow through the heart. Nature. 2000;404:759–61.
Markl M, Geiger J, Kilner PJ, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of cardiovascular flow paths in volunteers and patients with Fontan circulation. Eur J Cardiothorac Surg. 2011;39:206–12.
Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA. 1999;282:2035–42.
Frydrychowicz A, Stalder AF, Russe MF, et al. Three-dimensional analysis of segmental wall shear stress in the aorta by flow-sensitive four-dimensional-MRI. J Magn Reson Imaging. 2009;30:77–84.
Barker AJ, Markl M, Burk J, et al. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging. 2012;5:457–66.
Bieging ET, Frydrychowicz A, Wentland A, et al. In vivo three-dimensional MR wall shear stress estimation in ascending aortic dilatation. J Magn Reson Imaging. 2011;33:589–97.
Meierhofer C, Schneider EP, Lyko C, et al. Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study. Eur Heart J Cardiovasc Imaging. 2013;14:797–804.
Burk J, Blanke P, Stankovic Z, et al. Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR. J Cardiovasc Magn Reson. 2012;14:84.
Markl M, Wallis W, Brendecke S, Simon J, Frydrychowicz A, Harloff A. Estimation of global aortic pulse wave velocity by flow-sensitive 4D MRI. Magn Reson Med. 2010;63:1575–82.
Dyverfeldt P, Ebbers T, Lanne T. Pulse wave velocity with 4D flow MRI: systematic differences and age-related regional vascular stiffness. Magn Reson Imaging. 2014;32:1266–71.
Nishimura RA, Otto C. 2014 ACC/AHA valve guidelines: earlier intervention for chronic mitral regurgitation. Heart. 2014;100:905–7.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv. 2010;76:E43–86.
Wilton E, Jahangiri M. Post-stenotic aortic dilatation. J Cardiothorac Surg. 2006;1:7.
Hope MD, Dyverfeldt P, Acevedo-Bolton G, et al. Post-stenotic dilation: evaluation of ascending aortic dilation with 4D flow MR imaging. Int J Cardiol. 2012;156:e40–2.
van Ooij P, Potters WV, Nederveen AJ, et al. A methodology to detect abnormal relative wall shear stress on the full surface of the thoracic aorta using four-dimensional flow MRI. Magn Reson Med. 2015;73:1216–27.
Dyverfeldt P, Hope MD, Tseng EE, Saloner D. Magnetic resonance measurement of turbulent kinetic energy for the estimation of irreversible pressure loss in aortic stenosis. JACC Cardiovasc Imaging. 2013;6:64–71.
Barker AJ, van Ooij P, Bandi K, et al. Viscous energy loss in the presence of abnormal aortic flow. Magn Reson Med. 2014;72:620–8.
Barker AJ, Markl M. The role of hemodynamics in bicuspid aortic valve disease. Eur J Cardiothorac Surg. 2011;39:805–6.
Bissell MM, Hess AT, Biasiolli L, et al. Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging. 2013;6:499–507.
Hope MD, Wrenn J, Sigovan M, Foster E, Tseng EE, Saloner D. Imaging biomarkers of aortic disease: increased growth rates with eccentric systolic flow. J Am Coll Cardiol. 2012;60:356–7.
Hope MD, Meadows AK, Hope TA, et al. Clinical evaluation of aortic coarctation with 4D flow MR imaging. J Magn Reson Imaging. 2010;31:711–8.
Frydrychowicz A, Markl M, Hirtler D, et al. Aortic hemodynamics in patients with and without repair of aortic coarctation: in vivo analysis by 4D flow-sensitive magnetic resonance imaging. Investig Radiol. 2011;46:317–25.
Riesenkampff E, Fernandes JF, Meier S, et al. Pressure fields by flow-sensitive, 4D, velocity-encoded CMR in patients with aortic coarctation. JACC Cardiovasc Imaging. 2014;7:920–6.
Markl M, Draney MT, Miller DC, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of aortic flow in healthy volunteers and patients after valve-sparing aortic root replacement. J Thorac Cardiovasc Surg. 2005;130:456–63.
Semaan E, Markl M, Malaisrie SC, et al. Haemodynamic outcome at four-dimensional flow magnetic resonance imaging following valve-sparing aortic root replacement with tricuspid and bicuspid valve morphology. Eur J Cardiothorac Surg. 2014;45:818–25.
von Knobelsdorff-Brenkenhoff F, Dieringer MA, Greiser A, Schulz-Menger J. In vitro assessment of heart valve bioprostheses by cardiovascular magnetic resonance: four-dimensional mapping of flow patterns and orifice area planimetry. Eur J Cardiothorac Surg. 2011;40:736–42.
von Knobelsdorff-Brenkenhoff F, Trauzeddel RF, Barker AJ, Gruettner H, Markl M, Schulz-Menger J. Blood flow characteristics in the ascending aorta after aortic valve replacement-a pilot study using 4D-flow MRI. Int J Cardiol. 2014;170:426–33.
Trauzeddel F, Loebe U, Barker A, et al. Blood flow pattern in the ascending aorta after TAVI and conventional aortic valve replacement: analysis using 4D-flow MRI. Int J Cardiovasc Imaging. 2016;32:461–7.
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von Knobelsdorff-Brenkenhoff, F., Barker, A.J. (2019). 4D Flow MR: Insights into Aortic Blood Flow Characteristics. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_28
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DOI: https://doi.org/10.1007/978-3-7091-4874-7_28
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