Phase-contrast magnetic resonance imaging for analyzing hemodynamic parameters and wall shear stress of pulmonary arteries in patients with pulmonary arterial hypertension

  • Hung-Hsuan Wang
  • Wen-Yih Isaac Tseng
  • Hsi-Yu Yu
  • Meng-Chu Chang
  • Hsu-Hsia PengEmail author
Research article



To investigate flow-related parameters in pulmonary arteries of patients with pulmonary arterial hypertension (PAH).

Materials and methods

Eleven PAH patients and twelve control participants were recruited. PAH and controls had similar age and gender distribution. 2D phase-contrast MRI (PC-MRI) was performed in the main, right, and left pulmonary artery (MPA, RPA, and LPA). The flow velocity, wall shear stress (WSS), and oscillatory shear index (OSI) were measured.


PAH patients displayed prolonged acceleration time (Tacce) and increased ratio of flow change to acceleration volume in pulmonary arteries (both P < 0.001). The temporally averaged WSS values of MPA, RPA, and LPA in PAH patients were significantly lower than those of control participants (P < 0.001). The OSI in the pulmonary arteries was higher in PAH patients than control participants (P < 0.05). The ROC analysis indicated the ratio of maximum flow change to acceleration volume, WSS, and Tacce exhibited sufficient sensitivity and specificity to detect patients with PAH. The WSS demonstrated strong correlations with Tacce and the ratio value in the two groups (R2 = 0.78–0.96).


We used a clinically feasible 2D PC-MRI sequence with a reasonable scanning time to compute aforementioned indices. The quantitative parameters provided sufficient information to differentiate PAH patients from control participants.


Pulmonary arterial hypertension Magnetic resonance imaging Flow velocity Wall shear stress 



This study was funded by the National Science Council, Taiwan (NSC 102-2320-B-007-003-MY3; MOST 106-2314-B-007-006-MY3) and Veterans General Hospitals and University System of Taiwan Joint Research Program (VGHUST103-G3-1-1).


This study was funded by the Ministry of Science and Technology, Taiwan (NSC 102-2320-B-007-003-MY3; MOST 106-2314-B-007-006-MY3) and Veterans General Hospitals and University System of Taiwan Joint Research Program (VGHUST103-G3-1-1).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10334_2019_767_MOESM1_ESM.tif (731 kb)
Supplementary material 1 (TIF 731 kb)


  1. 1.
    Chin KM, Rubin LJ (2008) Pulmonary arterial hypertension. J Am Coll Cardiol 51(16):1527–1538CrossRefGoogle Scholar
  2. 2.
    Humbert M, Sitbon O, Yaici A, Montani D, O'Callaghan DS, Jais X, Parent F, Savale L, Natali D, Gunther S, Chaouat A, Chabot F, Cordier JF, Habib G, Gressin V, Jing ZC, Souza R, Simonneau G (2010) Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension. Eur Respir J 36(3):549–555CrossRefGoogle Scholar
  3. 3.
    Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, Yaici A, Weitzenblum E, Cordier JF, Chabot F, Dromer C, Pison C, Reynaud-Gaubert M, Haloun A, Laurent M, Hachulla E, Cottin V, Degano B, Jais X, Montani D, Souza R, Simonneau G (2010) Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era. Circulation 122(2):156–163CrossRefGoogle Scholar
  4. 4.
    Batt J, Shadly Ahmed S, Correa J, Bain A, Granton J (2013) Skeletal muscle dysfunction in idiopathic pulmonary arterial hypertension. Am J Respir Cell Mol BiolGoogle Scholar
  5. 5.
    Ley S, Mereles D, Puderbach M, Gruenig E, Schock H, Eichinger M, Ley-Zaporozhan J, Fink C, Kauczor HU (2007) Value of MR phase-contrast flow measurements for functional assessment of pulmonary arterial hypertension. Eur Radiol 17(7):1892–1897CrossRefGoogle Scholar
  6. 6.
    Mousseaux ETJ, Jolivet O, Simonneau G, Bittoun J, Gaux JC (1999) Pulmonary arterial resistance: noninvasive measurement with indexes of pulmonary flow estimated at velocity-encoded MR imaging—preliminary experience1. Radiology 212:896–902CrossRefGoogle Scholar
  7. 7.
    Kondo C, Caputo GR, Masui T, Foster E, O'Sullivan M, Stulbarg MS, Golden J, Catterjee K, Higgins CB (1992) Pulmonary hypertension: pulmonary flow quantification and flow profile analysis with velocity-encoded cine MR imaging. Radiology 183(3):751–758CrossRefGoogle Scholar
  8. 8.
    Wang JJOBA, Shrive NG, Parker KH, Tyberg JV (2003) Time-domain representation of ventricular-arterial coupling as a windkessel and wave system. Am J Physiol Heart Circ Physiol 284(4):H1358–H1368CrossRefGoogle Scholar
  9. 9.
    Zarins CK, Giddens DP, Bharadvaj BK, Sottiurai VS, Mabon RF, Glagov S (1983) Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res 53(4):502–514.CrossRefGoogle Scholar
  10. 10.
    Chien S (2007) Mechanotransduction and endothelial cell homeostasis: the wisdom of the cell. Am J Physiol Heart Circ Physiol 292(3):H1209–1224CrossRefGoogle Scholar
  11. 11.
    Chien S, Li S, Shyy YJ (1998) Effects of mechanical forces on signal transduction and gene expression in endothelial cells. Hypertension 31(1 Pt 2):162–169CrossRefGoogle Scholar
  12. 12.
    Cheng C, Tempel D, van Haperen R, van der Baan A, Grosveld F, Daemen MJ, Krams R, de Crom R (2006) Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress. Circulation 113(23):2744–2753CrossRefGoogle Scholar
  13. 13.
    Francois CJ, Srinivasan S, Schiebler ML, Reeder SB, Niespodzany E, Landgraf BR, Wieben O, Frydrychowicz A (2012) 4D cardiovascular magnetic resonance velocity mapping of alterations of right heart flow patterns and main pulmonary artery hemodynamics in tetralogy of Fallot. J Cardiovasc Magn Reson 14:16CrossRefGoogle Scholar
  14. 14.
    Barker AJ, Lanning C, Shandas R (2010) Quantification of hemodynamic wall shear stress in patients with bicuspid aortic valve using phase-contrast MRI. Ann Biomed Eng 38(3):788–800CrossRefGoogle Scholar
  15. 15.
    Stalder AF, Russe MF, Frydrychowicz A, Bock J, Hennig J, Markl M (2008) Quantitative 2D and 3D phase contrast MRI: optimized analysis of blood flow and vessel wall parameters. Magn Reson Med 60(5):1218–1231CrossRefGoogle Scholar
  16. 16.
    Tang BT, Pickard SS, Chan FP, Tsao PS, Taylor CA, Feinstein JA (2012) Wall shear stress is decreased in the pulmonary arteries of patients with pulmonary arterial hypertension: an image-based, computational fluid dynamics study. Pulm Circ 2(4):470–476CrossRefGoogle Scholar
  17. 17.
    Barker AJ, Roldan-Alzate A, Entezari P, Shah SJ, Chesler NC, Wieben O, Markl M, Francois CJ (2015) Four-dimensional flow assessment of pulmonary artery flow and wall shear stress in adult pulmonary arterial hypertension: results from two institutions. Magn Reson Med 73(5):1904–1913CrossRefGoogle Scholar
  18. 18.
    Schafer M, Kheyfets VO, Schroeder JD, Dunning J, Shandas R, Buckner JK, Browning J, Hertzberg J, Hunter KS, Fenster BE (2016) Main pulmonary arterial wall shear stress correlates with invasive hemodynamics and stiffness in pulmonary hypertension. Pulm Circ 6(1):37–45CrossRefGoogle Scholar
  19. 19.
    Tardivon AA, Mousseaux E, Brenot F, Bittoun J, Jolivet O, Bourroul E, Duroux P (1994) Quantification of hemodynamics in primary pulmonary hypertension with magnetic resonance imaging. Am J Respir Crit Care Med 150(4):1075–1080CrossRefGoogle Scholar
  20. 20.
    Prapa M, McCarthy KP, Dimopoulos K, Sheppard MN, Krexi D, Swan L, Wort SJ, Gatzoulis MA, Ho SY (2013) Histopathology of the great vessels in patients with pulmonary arterial hypertension in association with congenital heart disease: large pulmonary arteries matter too. Int J CardiolGoogle Scholar
  21. 21.
    Chiu JJ, Usami S, Chien S (2009) Vascular endothelial responses to altered shear stress: pathologic implications for atherosclerosis. Ann Med 41(1):19–28CrossRefGoogle Scholar
  22. 22.
    Cunningham KS, Gotlieb AI (2005) The role of shear stress in the pathogenesis of atherosclerosis. Lab Invest 85(1):9–23CrossRefGoogle Scholar
  23. 23.
    Efstathopoulos EP, Patatoukas G, Pantos I, Benekos O, Katritsis D, Kelekis NL (2008) Wall shear stress calculation in ascending aorta using phase contrast magnetic resonance imaging. Investigating effective ways to calculate it in clinical practice. Phys Med 24(4):175–181CrossRefGoogle Scholar
  24. 24.
    Butler PJ, Weinbaum S, Chien S, Lemons DE (2000) Endothelium-dependent, shear-induced vasodilation is rate-sensitive. Microcirculation 7(1):53–65CrossRefGoogle Scholar
  25. 25.
    Shaaban AM, Duerinckx AJ (2000) Wall shear stress and early atherosclerosis: a review. AJR Am J Roentgenol 174(6):1657–1665CrossRefGoogle Scholar
  26. 26.
    Bollache E, van Ooij P, Powell A, Carr J, Markl M, Barker AJ (2016) Comparison of 4D flow and 2D velocity-encoded phase contrast MRI sequences for the evaluation of aortic hemodynamics. Int J Cardiovasc Imaging 32(10):1529–1541CrossRefGoogle Scholar
  27. 27.
    Bachler P, Valverde I, Pinochet N, Nordmeyer S, Kuehne T, Crelier G, Tejos C, Irarrazaval P, Beerbaum P, Uribe S (2013) Caval blood flow distribution in patients with Fontan circulation: quantification by using particle traces from 4D flow MR imaging. Radiology 267(1):67–75CrossRefGoogle Scholar
  28. 28.
    Moral S, Fernandez-Friera L, Stevens G, Guzman G, Garcia-Alvarez A, Nair A, Evangelista A, Fuster V, Garcia MJ, Sanz J (2012) New index alpha improves detection of pulmonary hypertension in comparison with other cardiac magnetic resonance indices. Int J Cardiol 161(1):25–30CrossRefGoogle Scholar
  29. 29.
    Swift AJ, Rajaram S, Hurdman J, Hill C, Davies C, Sproson TW, Morton AC, Capener D, Elliot C, Condliffe R, Wild JM, Kiely DG (2013) Noninvasive estimation of PA pressure, flow, and resistance with CMR imaging: derivation and prospective validation study from the ASPIRE registry. JACC Cardiovasc ImagingGoogle Scholar

Copyright information

© European Society for Magnetic Resonance in Medicine and Biology (ESMRMB) 2019

Authors and Affiliations

  1. 1.Department of Biomedical Engineering and Environmental SciencesNational Tsing Hua UniversityHsinchuTaiwan
  2. 2.Institute of Medical Device and Imaging, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  3. 3.Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan

Personalised recommendations