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Direct measurement of aortic regurgitation with phase-contrast magnetic resonance is inaccurate: proposal of an alternative method of quantification

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Abstract

Background

Phase-contrast magnetic resonance (MR) has been widely used for quantification of aortic regurgitation. However there is significant practice variability regarding where and how the blood flow data are acquired.

Objective

To compare the accuracy of flow quantification of aortic regurgitation at three levels: the ascending aorta at the level of the right pulmonary artery (level 1), the aortic valve hinge points at end-diastole (level 2) and the aortic valve hinge points at end-systole (level 3).

Materials and methods

We performed cardiovascular MR in 43 children with aortic regurgitation. By using phase-contrast MR, we measured the systolic forward, diastolic retrograde and net forward flow volume indices at three levels. At each level, the following comparisons were made: (1) systolic forward flow volume index (FFVI) versus left ventricular cardiac index (LVCI) measured by cine ventricular volumetry; (2) retrograde flow volume index (RFVI) versus estimated aortic regurgitation volume index (which equals LVCI minus pulmonary blood flow index [QPI]); (3) net forward flow volume index (NFVI) versus pulmonary blood flow index.

Results

The forward flow volume index, retrograde flow volume index and net forward flow volume index measured at each of the three levels were significantly different except for the retrograde flow volume index measured at levels 1 and 3. There were good correlations between the forward flow volume index and the left ventricular cardiac index at all three levels, with measurement at level 2 showing the best correlation. Compared to the forward flow volume indices, the retrograde flow volume index had a lower correlation with the estimated aortic regurgitation volume indices and had widely dispersed data with larger prediction intervals.

Conclusion

Large variations in systolic forward, diastolic retrograde and net forward flow volumes were observed at different levels of the aortic valve and ascending aorta. Direct measurement of aortic regurgitation volume and fraction is inaccurate and should be abandoned. Instead, calculation of the aortic regurgitation volume from more reliable data is advised. We recommend subtracting pulmonary blood flow from systolic forward flow measured at the aortic valve hinge points at end-diastole as a more accurate and consistent method for calculating the volume of aortic regurgitation.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, Ontario, M5G1X8, Canada

    Yoichi Iwamoto, Akio Inage, Lars Grosse-Wortmann, Mike Seed & Shi-Joon Yoo

  2. Division of Cardiology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada

    Yoichi Iwamoto, Akio Inage, Kyong Jin Lee, Lars Grosse-Wortmann, Mike Seed, Andrea Wan & Shi-Joon Yoo

  3. Department of Medicine, Toronto General Hospital and Mt. Sinai Hospital, University of Toronto, Toronto, Canada

    George Tomlinson

Authors
  1. Yoichi Iwamoto
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  2. Akio Inage
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  3. George Tomlinson
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  4. Kyong Jin Lee
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  5. Lars Grosse-Wortmann
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  7. Andrea Wan
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  8. Shi-Joon Yoo
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Correspondence to Shi-Joon Yoo.

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Iwamoto, Y., Inage, A., Tomlinson, G. et al. Direct measurement of aortic regurgitation with phase-contrast magnetic resonance is inaccurate: proposal of an alternative method of quantification. Pediatr Radiol 44, 1358–1369 (2014). https://doi.org/10.1007/s00247-014-3017-x

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  • DOI: https://doi.org/10.1007/s00247-014-3017-x

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