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Real-time phase contrast magnetic resonance imaging for assessment of haemodynamics: from phantom to patients

  • Cardiac
  • Published:
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Abstract

Objectives

Assessment of haemodynamics is crucial in many cardiac diseases. Phase contrast MRI (PC-MRI) can accurately access it. Arrhythmia is a major limitation in conventional segmented PC-MRI (SEG). A real-time PC-MRI sequence (RT) could overcome this. We validated RT by comparing to SEG.

Methods

A prototype RT using shared velocity encoding was tested against SEG at 1.5 T in a flow phantom and consecutively included patients with (n = 55) or without (n = 59) aortic valve disease. In patients with atrial fibrillation (Afib, n = 15), only RT was applied.

Phantom: PC images were acquired in front of and behind an interchangeable aortic-stenosis-like inlay. Mean velocity and flow were quantified.

Patients: PC images were acquired in the ascending aorta, pulmonary trunk and superior caval vein. Peak velocity, stroke volume and regurgitant fraction were quantified.

Results

Phantom: Mean velocities (11 ± 1 to 207 ± 10 cm/s) and flow correlated closely between SEG and RT (r ≥ 0.99, ICC ≥ 0.98, p < 0.0005).

Patients without AVD or with aortic regurgitation: Concordance of SEG and RT was excellent regarding peak velocities, stroke volumes (r ≥ 0.91, ICC ≥ 0.94, p < 0.0005) and regurgitant fractions (r = 0.95, ICC = 0.95, p < 0.0005).

RT was feasible in all patients with Afib.

Conclusions

The real-time sequence is accurate compared to conventional segmented PC-MRI. Its applicability in Afib was shown. Real-time PC-MRI might become a valuable tool in arrhythmia.

Key Points

• Assessment of haemodynamics is crucial in many cardiac diseases.

• Arrhythmias are a major limitation of conventional techniques in cardiac magnetic resonance.

• A real-time technique, which allows application in arrhythmia, was validated.

• This real-time technique might become a valuable tool in arrhythmic patients.

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Abbreviations

Afib:

Atrial fibrillation

Ao asc:

Ascending aorta

AR:

Aortic valve regurgitation

AS:

Aortic valve stenosis

AVD:

Aortic valve disease

CMR:

Cardiovascular magnetic resonance

EPI:

Echo planar imaging

MPA:

Main pulmonary artery

PC-MRI:

Phase contrast magnetic resonance imaging

RF:

Regurgitant fraction

RT:

Real-time PC-MRI

SCV:

Superior caval vein

SEG:

Conventional gradient-echo PC-MRI

VOA:

Valve orifice area

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Acknowledgements

We thank Philipp Barckow from Circle Cardiovascular Imaging Inc., Calgary, Canada for adapting cvi42 post-processing software to our purposes as well as our technicians for their assistance in acquiring the images; furthermore, Dr. Fabian Mühlberg and Dr. Simone Fritschi for carefully reviewing the manuscript. The scientific guarantor of this publication is Jeanette Schulz-Menger. The authors of this manuscript declare relationships with the following companies: Matthias Dieringer and Andreas Greiser are employees of Siemens AG Healthcare Sector, Erlangen, Germany. Ning Jin is an employee of Siemens Medical Solutions USA, Inc., Columbus, USA. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, experimental, performed at one institution.

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Authors and Affiliations

  1. Department of Cardiology and Nephrology, Working Group on Cardiovascular Magnetic Resonance Imaging, Experimental and Clinical Research Center, Max-Delbrück-Centrum and Charité -Medical University Berlin and HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Julius Traber, Lennart Wurche, Matthias A. Dieringer, Wolfgang Utz, Florian von Knobelsdorff-Brenkenhoff & Jeanette Schulz-Menger

  2. Siemens AG Healthcare Sector, Erlangen, Germany

    Andreas Greiser

  3. Siemens Medical Solutions USA, Inc., Columbus, OH, USA

    Ning Jin

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  1. Julius Traber
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Correspondence to Julius Traber.

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Traber, J., Wurche, L., Dieringer, M.A. et al. Real-time phase contrast magnetic resonance imaging for assessment of haemodynamics: from phantom to patients. Eur Radiol 26, 986–996 (2016). https://doi.org/10.1007/s00330-015-3897-7

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  • DOI: https://doi.org/10.1007/s00330-015-3897-7

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