Assessment of mitral regurgitation by 3-dimensional proximal flow convergence using magnetic resonance imaging: comparison with echo-Doppler

  • Lior Gorodisky
  • Yoram Agmon
  • Moshe Porat
  • Sobhi Abadi
  • Jonathan Lessick
Original Paper


To test the feasibility of assessing mitral regurgitation (MR) severity using cardiac magnetic resonance (CMR) 4D velocity vectors to quantify regurgitant volume (RVol) by analysis of the proximal flow convergence, compared to Doppler based proximal isovelocity surface area (PISA) and CMR volume-based methods. In a prospectively designed study, 27 patients with various grades of MR underwent CMR and echo-Doppler on the same day. By CMR, multiple slices were obtained parallel to the mitral valve by phase-contrast imaging, using 3D velocity vectors, as well as short-axis cine images for left and right ventricular volume measurements. Using dedicated software developed in our laboratory, the perimeter of the proximal flow convergence region was semi-automatically measured for each temporal phase, and for each short-axis slice. The CMR-PISA RVol was calculated as the sum of PISA perimeters throughout systole, multiplied by slice width. For comparison, CMR-volumetric RVol was calculated by 2 methods: Volumetric (difference between left and right ventricular stroke volumes) and Flow-based (stroke volume -aortic flow). Echo-PISA RVol was calculated by echo-Doppler based PISA method. RVol by CMR-PISA correlated highly with echo-PISA (r = 0.87) and with CMR-volumetric (r = 0.86) and CMR-flow (r = 0.72). For comparison Doppler-RVol and CMR-volume-based RVol had r = 0.83. On average CMR-PISA was 16 ± 25 ml less than echo-PISA, but 12 ± 22 ml larger than CMR-volumetric RVol. The observed 3D shape of the PISA envelope by 4D-CMR resembled a hemiellipsoid rather than a hemisphere. This feasibility study suggests that CMR-based 4D-PISA may be able to assess MR severity quantitatively without any geometric assumptions.


Valve disease Regurgitant volume Computer-aided analysis Proximal isovelocity surface area 



The study was funded by the Atkins Medical Research Fund, a research grant provided by the Technion-Israel Institute of Technology for “Interdisciplinary Cooperation of the Medical Faculty with the Faculty of Electrical Engineering”.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Ethics committee approval was given by the Rambam Helsinki Committee (RMB-11-0282).

Informed consent

All patients signed informed consent before entering the study.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Cardiology DepartmentRambam Health Care CampusHaifaIsrael
  2. 2.Medical Imaging DepartmentRambam Health Care CampusHaifaIsrael
  3. 3.Department of Electrical EngineeringTechnion-Israel Institute of TechnologyHaifaIsrael
  4. 4.Department of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael

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