Conventional 4D Flow Research Articles

Observation of intracranial artery and venous sinus hemodynamics using compressed sensing-accelerated 4D flow MRI: performance at different acceleration factors.

To investigate the feasibility and performance of 4D flow MRI accelerated by compressed sensing (CS) for the hemodynamic quantification of intracranial artery and venous sinus. Forty healthy volunteers were prospectively recruited, and 20 volunteers underwent 4D flow MRI of cerebral artery, and the remaining volunteers underwent 4D flow MRI of venous sinus. A series of 4D flow MRI was acquired with different acceleration factors (AFs), including sensitivity encoding (SENSE, AF = 4) and CS (AF = CS4, CS6, CS8, and CS10) at a 3.0 T MRI scanner. The hemodynamic parameters, including flow rate, mean velocity, peak velocity, max axial wall shear stress (WSS), average axial WSS, max circumferential WSS, average circumferential WSS, and 3D WSS, were calculated at the internal carotid artery (ICA), transverse sinus (TS), straight sinus (SS), and superior sagittal sinus (SSS). Compared to the SENSE4 scan, for the left ICA C2, mean velocity measured by CS8 and CS10 groups, and 3D WSS measured by CS6, CS8, and CS10 groups were underestimated; for the right ICA C2, mean velocity measured by CS10 group, and 3D WSS measured by CS8 and CS10 groups were underestimated; for the right ICA C4, mean velocity measured by CS10 group, and 3D WSS measured by CS8 and CS10 groups were underestimated; and for the right ICA C7, mean velocity and 3D WSS measured by CS8 and CS10 groups, and average axial WSS measured by CS8 group were also underestimated (all p < 0.05). For the left TS, max axial WSS and 3D WSS measured by CS10 group were significantly underestimated (p = 0.032 and 0.003). Similarly, for SS, mean velocity, peak velocity, average axial WSS measured by the CS8 and CS10 groups, max axial WSS measured by CS6, CS8, and CS10 groups, and 3D WSS measured by CS10 group were significantly underestimated compared to the SENSE4 scan (p = 0.000-0.021). The hemodynamic parameters measured by CS4 group had only minimal bias and great limits of agreement compared to conventional 4D flow (SENSE4) in the ICA and every venous sinus (the max/min upper limit to low limit of the 95% limits of agreement = 11.4/0.03 to 0.004/-5.7, 14.4/0.05 to -0.03/-9.0, 12.6/0.04 to -0.03/-9.4, 16.8/0.04 to 0.6/-14.1; the max/min bias = 5.0/-1.2, 3.5/-1.4, 4.5/-1.1, 6.6/-4.0 for CS4, CS6, CS8, and CS10, respectively). CS4 strikes a good balance in 4D flow between flow quantifications and scan time, which could be recommended for routine clinical use.

Highly accelerated compressed sensing 4D flow MRI in congenital and acquired heart disease: comparison of aorta and main pulmonary artery flow parameters with conventional 4D flow MRI in children and young adults.

Four-dimensional flow (4D flow) MRI has become a clinically utilized cardiovascular flow assessment tool. However, scans can be lengthy and may require anesthesia in younger children. Adding compressed sensing can decrease scan time, but its impact on hemodynamic data accuracy needs additional assessment. To compare 4D flow hemodynamics acquired with and without compressed sensing. Twenty-seven patients (median age: 13 [IQR: 9.5] years) underwent conventional and compressed sensing cardiovascular 4D flow following informed consent. Conventional 4D flow was performed using parallel imaging and an acceleration factor of 2. Compressed sensing 4D flow was performed with an acceleration factor of 7.7. Regions of interest were placed to compare flow parameters in the ascending aorta and main pulmonary artery. Paired Student's t-tests, Wilcoxon signed-rank tests, Bland-Altman plots, and intraclass correlation coefficients were conducted. A P-value of < 0.05 was considered statistically significant. Mean scan acquisition time was reduced by 59% using compressed sensing (3.4 vs. 8.2min, P < 0.001). Flow quantification was similar for compressed sensing and conventional 4D flow for the ascending aorta net flow: 47 vs. 49ml/beat (P = 0.28); forward flow: 49 vs. 50ml/beat (P = 0.07), and main pulmonary artery net flow: 49 vs. 51ml/beat (P = 0.18); forward flow: 50 vs. 55ml/beat (P = 0.07). Peak systolic velocity was significantly underestimated by compressed sensing 4D flow in the ascending aorta: 114 vs. 128cm/s (P < 0.001) and main pulmonary artery: 106 vs. 112cm/s (P = 0.02). For both the aorta and main pulmonary artery, compressed sensing 4D flow provided equivalent net and forward flow values compared to conventional 4D flow but underestimated peak systolic velocity. By reducing scan time, compressed sensing 4D flow may decrease the need for anesthesia and increase scanner output without significantly compromising data integrity.

Motion-resolved real-time 4D flow MRI withlow-rank and subspace modeling.

To develop a new motion-resolved real-time four-dimensional (4D) flow MRI method, which enables the quantification and visualization of blood flow velocities with three-directional flow encodings and volumetric coverage without electrocardiogram (ECG) synchronization and respiration control. An integrated imaging method is presented for real-time 4D flow MRI, which encompasses data acquisition, image reconstruction, and postprocessing. The proposed method features a specialized continuous -space acquisition scheme, which collects two sets of data (i.e., training data and imaging data) in an interleaved manner. By exploiting strong spatiotemporal correlation of 4D flow data, it reconstructs time-series images from highly-undersampled -space measurements with a low-rank and subspace model. Through data-binning-based postprocessing, it constructs a five-dimensional dataset (i.e., x-y-z-cardiac-respiratory), from which respiration-dependent flow information is further analyzed. The proposed method was evaluated in aortic flow imaging experiments with ten healthy subjects and two patients with atrial fibrillation. The proposed method achieves 2.4 mm isotropic spatial resolution and 34.4 ms temporal resolution for measuring the blood flow of the aorta. For the healthy subjects, it provides flow measurements in good agreement with those from the conventional 4D flow MRI technique. For the patients with atrial fibrillation, it is able to resolve beat-by-beat pathological flow variations, which cannot be obtained from the conventional technique. The postprocessing further provides respiration-dependent flow information. The proposed method enables high-resolution motion-resolved real-time 4D flow imaging without ECG gating and respiration control. It is able to resolve beat-by-beat blood flow variations as well as respiration-dependent flow information.

5D Flow MRI: A Fully Self-gated, Free-running Framework for Cardiac and Respiratory Motion-resolved 3D Hemodynamics.

To implement, validate, and apply a self-gated free-running whole-heart five-dimensional (5D) flow MRI framework to evaluate respiration-driven effects on three-dimensional (3D) hemodynamics in a clinical setting. In this prospective study, a free-running five-dimensional (5D) flow sequence was implemented with 3D radial sampling, self-gating, and a compressed-sensing reconstruction. The 5D flow was evaluated in a pulsatile phantom and adult participants with aortic and/or valvular disease who were enrolled between May and August 2019. Conventional twofold-accelerated four-dimensional (4D) flow of the thoracic aorta with navigator gating was performed as a reference comparison. Continuous parameters were evaluated for parameter normality and were compared between conventional 4D flow and 5D flow using a signed-rank or two-tailed paired t test. Differences between respiratory states were evaluated using a repeated-measure analysis of variance or a nonparametric Friedman test. A total of 20 adult participants (mean age, 49 years ± 17 [standard deviation]; 18 men and two women) were included. In vitro 5D flow results showed excellent agreement with conventional 4D flow-derived values (peak and net flow, <7% difference over all quantified planes). Whole-heart 5D flow data were collected in all participants in 7.65 minutes ± 0.35 (acceleration rate = 36.0-76.9) versus 9.88 minutes ± 3.17 for conventional aortic 4D flow. In vivo, 5D flow demonstrated moderate agreement with conventional 4D flow but demonstrated overestimation in net flow and peak velocity (up to 26% and 12%, respectively) in the ascending aorta and underestimation (<12%) in the arch and descending aorta. Respiratory-resolved analyses of caval veins showed significantly increased net and peak flow in the inferior vena cava in end inspiration compared with end expiration, and the opposite trend was shown in the superior vena cava. A free-running 5D flow MRI framework consistently captured cardiac and respiratory motion-resolved 3D hemodynamics in less than 8 minutes. Supplemental material is available for this article. © RSNA, 2020.

Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease.

To systematically assess the feasibility and performance of a highly accelerated compressed sensing (CS) 4D flow MRI framework at three different acceleration factors (R) for the quantification of aortic flow dynamics and wall shear stress (WSS) in patients with aortic disease. Twenty patients with aortic disease (58 ± 15 y old; 19 M) underwent four 4D flow scans: one conventional (GRAPPA, R = 2) and three CS 4D flows with R = 5.7, 7.7, and 10.2. All scans were acquired with otherwise equivalent imaging parameters on a 1.5T scanner. Peak-systolic velocity (Vmax ), peak flow (Qmax ), and net flow (Qnet ) were quantified at the ascending aorta (AAo), arch, and descending aorta (DAo). WSS was calculated at six regions within the AAo and arch. Mean scan times for the conventional and CS 4D flows with R = 5.7, 7.7, and 10.2 were 9:58 ± 2:58 min, 3:40 ± 1:19 min, 2:50 ± 0:56 min, and 2:05 ± 0:42 min, respectively. Vmax , Qmax , and Qnet were significantly underestimated by all CS protocols (underestimation ≤ -7%, -9%, and -10% by CS, R = 5.7, 7.7, and 10.2, respectively). WSS measurements showed the highest underestimation by all CS protocols (underestimation ≤ -9%, -12%, and -14% by CS, R = 5.7, 7.7, and 10.2). Highly accelerated aortic CS 4D flow at R = 5.7, 7.7, and 10.2 showed moderate agreement with the conventional 4D flow, despite systematically underestimating various hemodynamic parameters. The shortened scan time may enable the clinical translation of CS 4D flow, although potential hemodynamic underestimation should be considered when interpreting the results.

Left Ventricular Flow Analysis in Atrial Fibrillation.

Atrial fibrillation (AF) is a global common disease which 33.5 million individuals suffer from. Conventional cardiac magnetic resonance and 4D flow magnetic resonance imaging have been used to study AF patients. We propose a left ventricular flow component analysis from 4D flow for AF detection. This method was applied to healthy controls and AF patients before catheter ablation. Retained inflow, delayed ejection, and residual volume had a significant difference between controls and the AF group as well as a conventional LV stroke volume parameter, and among them, residual volume was the strongest parameter to detect AF.

In vitro experiments on ICOSA6 4D flow MRI measurement for the quantification of velocity and turbulence parameters

PurposeTo perform comprehensive in vitro experiments using six-directional icosahedral flow encoding (ICOSA6) 4D flow magnetic resonance imaging (MRI) under various scan conditions to analyze the robustness of velocity and turbulence quantification. Materials and methodsIn vitro flow phantoms with steady flow rates of 10 and 20 L/min were scanned using both conventional 4D flow MRI and ICOSA6. Experiments focused on comparisons between ICOSA6 and conventional four point (4P) methods, and the effects of contrast agents, velocity encoding range (Venc), and scan direction on velocity and turbulence quantification. ResultsThe results demonstrated that 1) ICOSA6 improves the velocity-to-noise ratio (VNR) of velocity estimation by 33% (on average) and results in similar turbulent kinetic energy (TKE) estimation as the 4P method. 2) Measurements with a contrast agent resulted in more than a 2.5 fold increase in average VNR. However, the improvement of total TKE quantification was not obvious. 3) TKE estimation was less affected by Venc and the scan direction, whereas turbulence production (TP) estimation was largely affected by these measurement conditions. The effects of Venc and scan direction accounted for less than 11.63% of TKE estimation, but up to 33.89% of TP estimation. ConclusionThe ICOSA6 scheme is compatible with conventional 4D flow MRI for velocity and TKE measurement. Contrast agents are effective at increasing VNR, but not signal-to-noise ratio for TKE quantification. The effects of Venc and scan direction influence total TP more than total TKE.

High Spatiotemporal Resolution 4D Flow MRI of Intracranial Aneurysms at 7T in 10 Minutes.

Patients with intracranial aneurysms may benefit from 4D flow MR imaging because the derived wall shear stress is considered a useful marker for risk assessment and growth of aneurysms. However, long scan times limit the clinical implementation of 4D flow MR imaging. Therefore, this study aimed to investigate whether highly accelerated, high resolution, 4D flow MR imaging at 7T provides reliable quantitative blood flow values in intracranial arteries and aneurysms. We used pseudospiral Cartesian undersampling with compressed sensing reconstruction to achieve high spatiotemporal resolution (0.5 mm isotropic, ∼30 ms) in a scan time of 10 minutes. We analyzed the repeatability of accelerated 4D flow scans and compared flow rates, stroke volume, and the pulsatility index with 2D flow and conventional 4D flow MR imaging in a flow phantom and 15 healthy subjects. Additionally, accelerated 4D flow MR imaging with high spatiotemporal resolution was acquired in 5 patients with aneurysms to derive wall shear stress. Flow-rate bias compared with 2D flow was lower for accelerated than for conventional 4D flow MR imaging (0.31 ± 0.13, P = .22, versus 0.79 ± 0.17 mL/s, P < .01). Pulsatility index bias gave similar results. Stroke volume bias showed no difference for accelerated as well as for conventional 4D flow compared to 2D flow MR imaging. Repeatability for accelerated 4D flow was similar to that of 2D flow MR imaging. Increased temporal resolution for wall shear stress measurements in 5 intracranial aneurysms did not show a consistent effect for the wall shear stress but did show an effect for the oscillatory shear index. Highly accelerated high spatiotemporal resolution 4D flow MR imaging at 7T in intracranial arteries and aneurysms provides repeatable and accurate quantitative flow values. Flow rate accuracy is significantly increased compared with conventional 4D flow scans.

Two-Minute k-Space and Time-accelerated Aortic Four-dimensional Flow MRI: Dual-Center Study of Feasibility and Impact on Velocity and Wall Shear Stress Quantification.

To investigate the two-center feasibility of highly k-space and time (k-t)-accelerated 2-minute aortic four-dimensional (4D) flow MRI and to evaluate its performance for the quantification of velocities and wall shear stress (WSS). This cross-sectional study prospectively included 68 participants (center 1, 11 healthy volunteers [mean age ± standard deviation, 61 years ± 15] and 16 patients with aortic disease [mean age, 60 years ± 10]; center 2, 14 healthy volunteers [mean age, 38 years ± 13] and 27 patients with aortic or cardiac disease [mean age, 78 years ± 18]). Each participant underwent highly accelerated 4D flow MRI (k-t acceleration, acceleration factor of 5) of the thoracic aorta. For comparison, conventional 4D flow MRI (acceleration factor of 2) was acquired in the participants at center 1 (n = 27). Regional aortic peak systolic velocities and three-dimensional WSS were quantified. k-t-accelerated scan times (center 1, 2:03 minutes ± 0:29; center 2, 2:06 minutes ± 0:20) were significantly reduced compared with conventional 4D flow MRI (center 1, 12:38 minutes ± 2:25; P < .0001). Overall good agreement was found between the two techniques (absolute differences ≤15%), but proximal aortic WSS was significantly underestimated in patients by using k-t-accelerated 4D flow when compared with conventional 4D flow (P ≤ .03). k-t-accelerated 4D flow MRI was reproducible (intra- and interobserver intraclass correlation coefficient ≥0.98) and identified significantly increased peak velocities and WSS in patients with stenotic (P ≤ .003) or bicuspid (P ≤ .04) aortic valves compared with healthy volunteers. In addition, k-t-accelerated 4D flow MRI-derived velocities and WSS were inversely related to age (r ≥-0.53; P ≤ .03) over all healthy volunteers. k-t-accelerated aortic 4D flow MRI providing 2-minute scan times was feasible and reproducible at two centers. Although consistent healthy aging- and disease-related changes in aortic hemodynamics were observed, care should be taken when considering WSS, which can be underestimated in patients.© RSNA, 2019See also the commentary by François in this issue.

Comparison of turbulent flow measurement schemes for 4D flow MRI

Recently, time-resolved 3D phase contrast magnetic resonance imaging, which is also called 4D flow MRI or 4D PC-MRI, has been widely utilized to investigate spatial and temporal variations in the hemodynamic characteristics of blood flows. The conventional 4D flow MRI only provides the ensemble-averaged mean flow information but misses flow fluctuation because of turbulence. There have been some new manners for turbulence quantification of the blood flow using 4D flow MRI to acquire the fluctuation intensity of the turbulent flow. Although the previous studies showed that a minimum of six flow encoding is needed to perfectly describe six independent components of the 3 × 3 symmetric Reynolds stress tensor, the optimum flow encoding scheme for turbulence has not been clearly revealed. In this study, we compared and evaluated the uncertainty of mean velocity and Reynolds stress tensor in 4D flow MRI with various flow encoding schemes. The results showed that six- to fifteen-direction measurements could result 29–51% less noise in the velocity field and 34–57% less noise in the TKE field. In addition, higher number of flow encoding had less noise in Reynolds stress estimation.

Time-optimized 4D phase contrast MRI with real-time convex optimization of gradient waveforms and fast excitation methods.

To shorten 4D flow acquisitions by shortening TRs with fast RF pulses and gradient waveforms. Real-time convex optimization is used to generate these gradients waveforms on the scanner. RF and slab-select waveforms were shortened with a minimum phase SLR excitation and the time-optimal variable-rate selective excitation method. Real-time convex optimization was used to shorten bipolar and spoiler gradients by finding the shortest gradient waveforms that satisfied constraints on scan parameters, gradient hardware, M0 , M1 , and peripheral nerve stimulation. Waveforms were calculated and TE and/or TR values were compared for a range of scan parameters and compared to a conventional 4D flow sequence. The method was tested in flow phantoms, and in the aorta and neurovasculature of volunteers (N = 10). Additionally, eddy current error was measured in a large phantom. TEs and TRs were shortened by 21-32% and 20-34%, respectively, compared to the conventional sequence over a range of scan parameters. Bland-Altman analysis of 2 flow phantom configurations showed flow rate bias of 0.3 mL/s and limits of agreement (LOA) of [-6.9, 7.5] mL/s for a cardiac phantom and a bias of -0.1 mL/s with LOA = [-0.4, 0.2] mL/s for a neuro phantom. Similar agreement was also seen for flow measurements in volunteers (bias = -1.0 and -0.1 mL/s, LOA = [-34.9, 33.0] and [-0.7, 0.6] mL/s). Measured eddy currents were 39% larger with the CVX + mpVERSE method. The real-time optimized 4D flow gradients and fast slab-selection excitation methods produced up to 34% faster TRs with excellent flow measurement agreement compared to a conventional 4D flow sequence.

Aortic 4D flow MRI in 2 minutes using compressed sensing, respiratory controlled adaptive k-space reordering, and inline reconstruction.

To evaluate the accuracy and feasibility of a free-breathing 4D flow technique using compressed sensing (CS), where 4D flow imaging of the thoracic aorta is performed in 2 min with inline image reconstruction on the MRI scanner in less than 5 min. The 10 in vitro 4D flow MRI scans were performed with different acceleration rates on a pulsatile flow phantom (9 CS acceleration factors [R = 5.4-14.1], 1 generalized autocalibrating partially parallel acquisition [GRAPPA] R = 2). Based on in vitro results, CS-accelerated 4D flow of the thoracic aorta was acquired in 20 healthy volunteers (38.3 ± 15.2 years old) and 11 patients with aortic disease (61.3 ± 15.1 years) with R = 7.7. A conventional 4D flow scan was acquired with matched spatial coverage and temporal resolution. CS depicted similar hemodynamics to conventional 4D flow in vitro, and in vivo, with >70% reduction in scan time (volunteers: 1:52 ± 0:25 versus 7:25 ± 2:35 min). Net flow values were within 3.5% in healthy volunteers, and voxel-by-voxel comparison demonstrated good agreement. CS significantly underestimated peak velocities (vmax ) and peak flow (Qmax ) in both volunteers and patients (volunteers: vmax , -16.2% to -9.4%, Qmax : -11.6% to -2.9%, patients: vmax , -11.2% to -4.0%; Qmax , -10.2% to -5.8%). Aortic 4D flow with CS is feasible in a two minute scan with less than 5 min for inline reconstruction. While net flow agreement was excellent, CS with R = 7.7 produced underestimation of Qmax and vmax ; however, these were generally within 13% of conventional 4D flow-derived values. This approach allows 4D flow to be feasible in clinical practice for comprehensive assessment of hemodynamics.

4D Flow CMR analysis in repaired Tetralogy of Fallot: Where we are and where we are going

Background 4D flow cardiovascular magnetic resonance (4D Flow CMR) enable time-varying and multidirectional comprehensive retrospective flow quantification in patients after repaired tetralogy of Fallot (TOF). This imaging modality must, however, prove its relevance compared to conventional CMR. Methods 4D flow and 2D flow MRI were acquired using a clinical 1.5T MRI scanner (GE; GE Healthcare, Milwaukee, WI, USA). The 4D flow data were acquired in 18 patients after repair of TOF and in 5 healthy controls during free breathing using retrospectively ECG-gated and navigator-gated three-dimensional, three-directional phase contrast MRI (spatial resolution ∼ 1.4 mm, temporal resolution = 33 ms). Data analysis included the evaluation of haemodynamics in the aorta, the pulmonary trunk (TP), quantitative measurements of flow velocity, right ventricular volumes both by conventional 2D CMR and 4D Flow. Results Eighteen patients with TOF underwent 2D CMR and 4D Flow CMR (mean age 31 ± 13 years, mean size 168 ± 13 cm, mean weight 56.2 ± 13.4 kg). Among them 12 patients had complete evaluation including flow and ventricular volumes. The mean systolic ejection volume was 109 ± 44 mL; the mean right ventricle systolic function was 55 ± 12%. The mean end-diastolic right ventricle volume was respectively 185 ± 66 mL by 2D CMR, and 200 ± 68 mL using 4D Flow. The mean pulmonary regurgitation fraction was respectively 39 ± 18% by 2D CMR, and 32 ± 18% using 4D Flow. Pulmonary regurgitation fraction was almost interchangeable according to the Pearson's coefficient (r2 = 0.9, P Conclusions Based on our experience, 4D Flow imaging can be clinically helpful especially in TOF, compared to 2D CMR. Despite some biases, our results shows good accuracy compared to conventional 2D CMR. Further studies are needed to validate our first conclusions.

Accelerated phase contrast MRI using hybrid one- and two-sided flow encodings only (HOTFEO).

The aim of this work was to develop and evaluate a fast phase contrast magnetic resonance imaging (PC-MRI) technique with hybrid one- and two-sided flow encodings only (HOTFEO) for accurate blood flow and velocity measurements of three-directional velocity encoding PC-MRI. Four-dimensional (4D) PC-MRI acquires flow-compensated (FC) and three-directional flow-encoded (FE) echoes in an interleaved fashion. We hypothesize that the blood flow velocity direction (not magnitude) has minimal change between two consecutive cardiac phases. This assumption provides a velocity direction constraint that can achieve 4/3-fold acceleration using three-directional FE data to calculate FC data instead of acquiring them. The HOTFEO acquisition pattern can address the ill-conditioned constraint and improve the calculation accuracy. HOTFEO was evaluated in healthy volunteers and compared with conventional two-dimensional (2D) and 4D flow imaging techniques with FC and three-directional FE acquisitions (FC/3FE). Compared with FC/3FE, Bland-Altman tests showed that the 4/3-fold accelerated HOTFEO technique resulted in relatively small bias error for total volumetric flow (0.89% for prospective 2D data, -1.19% for retrospective 4D data and -3.40% for prospective 4D data) and maximum peak velocity (0.50% for prospective 2D data, -0.17% for retrospective 4D data and -2.00% for prospective 4D data) measurements in common carotid arteries. HOTFEO can accelerate three-directional velocity encoding PC-MRI whilst maintaining the measurement accuracy of the total volumetric flow and maximum peak velocity.

Self-gated golden-angle spiral 4D flow MRI.

PurposeThe acquisition of 4D flow magnetic resonance imaging (MRI) in cardiovascular applications has recently made large progress toward clinical feasibility. The need for simultaneous compensation of cardiac and breathing motion still poses a challenge for widespread clinical use. Especially, breathing motion, addressed by gating approaches, can lead to unpredictable and long scan times. The current work proposes a time‐efficient self‐gated 4D flow sequence that exploits up to 100% of the acquired data and operates at a predictable scan time.MethodsA self‐gated golden‐angle spiral 4D flow sequence was implemented and tested in 10 volunteers. Data were retrospectively binned into respiratory and cardiac states and reconstructed using a conjugate‐gradient sensitivity encoding reconstruction. Net flow curves, stroke volumes, and peak flow in the aorta were evaluated and compared to a conventional Cartesian 4D flow sequence. Additionally, flow quantities reconstructed from 50% to 100% of the self‐gated 4D flow data were compared.ResultsSelf‐gating signals for respiratory and cardiac motion were extracted for all volunteers. Flow quantities were in agreement with the standard Cartesian scan. Mean differences in stroke volumes and peak flow of 7.6 ± 11.5 and 4.0 ± 79.9 mL/s were obtained, respectively. By retrospectively increasing breathing navigator efficiency while decreasing acquisition times (15:06–07:33 minutes), 50% of the acquired data were sufficient to measure stroke volumes with errors under 9.6 mL.ConclusionThe feasibility to acquire respiratory and cardiac self‐gated 4D flow data at a predictable scan time was demonstrated. Magn Reson Med 80:904–913, 2018. © 2018 International Society for Magnetic Resonance in Medicine.

K-t accelerated aortic 4D flow MRI in under two minutes: Feasibility and impact of resolution, k-space sampling patterns, and respiratory navigator gating on hemodynamic measurements.

To assess the performance of highly accelerated free-breathing aortic four-dimensional (4D) flow MRI acquired in under 2 minutes compared to conventional respiratory gated 4D flow. Eight k-t accelerated nongated 4D flow MRI (parallel MRI with extended and averaged generalized autocalibrating partially parallel acquisition kernels [PEAK GRAPPA], R = 5, TRes = 67.2 ms) using four ky -kz Cartesian sampling patterns (linear, center-out, out-center-out, random) and two spatial resolutions (SRes1 = 3.5 × 2.3 × 2.6 mm3 , SRes2 = 4.5 × 2.3 × 2.6 mm3 ) were compared in vitro (aortic coarctation flow phantom) and in 10 healthy volunteers, to conventional 4D flow (16 mm-navigator acceptance window; R = 2; TRes = 39.2 ms; SRes = 3.2 × 2.3 × 2.4 mm3 ). The best k-t accelerated approach was further assessed in 10 patients with aortic disease. The k-t accelerated in vitro aortic peak flow (Qmax), net flow (Qnet), and peak velocity (Vmax) were lower than conventional 4D flow indices by ≤4.7%, ≤ 11%, and ≤22%, respectively. In vivo k-t accelerated acquisitions were significantly shorter but showed a trend to lower image quality compared to conventional 4D flow. Hemodynamic indices for linear and out-center-out k-space samplings were in agreement with conventional 4D flow (Qmax ≤ 13%, Qnet ≤ 13%, Vmax ≤ 17%, P > 0.05). Aortic 4D flow MRI in under 2 minutes is feasible with moderate underestimation of flow indices. Differences in k-space sampling patterns suggest an opportunity to mitigate image artifacts by an optimal trade-off between scan time, acceleration, and k-space sampling. Magn Reson Med 79:195-207, 2018. © 2018 International Society for Magnetic Resonance in Medicine.

4D spiral imaging of flows in stenotic phantoms and subjects with aortic stenosis.

The utility of four-dimensional (4D) spiral flow in imaging of stenotic flows in both phantoms and human subjects with aortic stenosis is investigated. The method performs 4D flow acquisitions through a stack of interleaved spiral k-space readouts. Relative to conventional 4D flow, which performs Cartesian readout, the method has reduced echo time. Thus, reduced flow artifacts are observed when imaging high-speed stenotic flows. Four-dimensional spiral flow also provides significant savings in scan times relative to conventional 4D flow. In vitro experiments were performed under both steady and pulsatile flows in a phantom model of severe stenosis (one inch diameter at the inlet, with 87% area reduction at the throat of the stenosis) while imaging a 6-cm axial extent of the phantom, which included the Gaussian-shaped stenotic narrowing. In all cases, gradient strength and slew rate for standard clinical acquisitions, and identical field of view and resolution were used. For low steady flow rates, quantitative and qualitative results showed a similar level of accuracy between 4D spiral flow (echo time [TE] = 2 ms, scan time = 40 s) and conventional 4D flow (TE = 3.6 ms, scan time = 1:01 min). However, in the case of high steady flow rates, 4D spiral flow (TE = 1.57 ms, scan time = 38 s) showed better visualization and accuracy as compared to conventional 4D flow (TE = 3.2 ms, scan time = 51 s). At low pulsatile flow rates, a good agreement was observed between 4D spiral flow (TE = 2 ms, scan time = 10:26 min) and conventional 4D flow (TE = 3.6 ms, scan time = 14:20 min). However, in the case of high flow-rate pulsatile flows, 4D spiral flow (TE = 1.57 ms, scan time = 10:26 min) demonstrated better visualization as compared to conventional 4D flow (TE = 3.2 ms, scan time = 14:20 min). The feasibility of 4D spiral flow was also investigated in five normal volunteers and four subjects with mild-to-moderate aortic stenosis. The approach achieved TE = 1.68 ms and scan time = 3:44 min. The conventional sequence achieved TE = 2.9 ms and scan time = 5:23 min. In subjects with aortic stenosis, we also compared both MRI methods with Doppler ultrasound (US) in the measurement of peak velocity, time to peak systolic velocity, and eject time. Bland-Altman analysis revealed that, when comparing peak velocities, the discrepancy between Doppler US and 4D spiral flow was significantly less than the discrepancy between Doppler and 4D Cartesian flow (2.75 cm/s vs. 10.25 cm/s), whereas the two MR methods were comparable (-5.75 s vs. -6 s) for time to peak. However, for the estimation of eject time, relative to Doppler US, the discrepancy for 4D conventional flow was smaller than that of 4D spiral flow (-16.25 s vs. -20 s). Relative to conventional 4D flow, 4D spiral flow achieves substantial reductions in both the TE and scan times; therefore, utility for it should be sought in a variety of in vivo and complex flow imaging applications.

Retrospectively gated intracardiac 4D flow MRI using spiral trajectories

PurposeTo develop and evaluate retrospectively gated spiral readout four‐dimensional (4D) flow MRI for intracardiac flow analysis.MethodsRetrospectively gated spiral 4D flow MRI was implemented on a 1.5‐tesla scanner. The spiral sequence was compared against conventional Cartesian 4D flow (SENSE [sensitivity encoding] 2) in seven healthy volunteers and three patients (only spiral). In addition to comparing flow values, linear regression was used to assess internal consistency of aortic versus pulmonary net volume flows and left ventricular inflow versus outflow using quantitative pathlines analysis.ResultsTotal scan time with spiral 4D flow was 44% ± 6% of the Cartesian counterpart (13 ± 3 vs. 31 ± 7 min). Aortic versus pulmonary flow correlated strongly for the spiral sequence (P < 0.05, slope = 1.03, R2 = 0.88, N = 10), whereas the linear relationship for the Cartesian sequence was not significant (P = 0.06, N = 7). Pathlines analysis indicated good data quality for the spiral (P < 0.05, slope = 1.02, R2 = 0.90, N = 10) and Cartesian sequence (P < 0.05, slope = 1.10, R2 = 0.93, N = 7). Spiral and Cartesian peak flow rate (P < 0.05, slope = 0.96, R2 = 0.72, N = 14), peak velocity (P < 0.05, slope = 1.00, R2 = 0.81, N = 14), and pathlines flow components (P < 0.05, slope = 1.04, R2 = 0.87, N = 28) correlated well.ConclusionRetrospectively gated spiral 4D flow MRI permits more than two‐fold reduction in scan time compared to conventional Cartesian 4D flow MRI, while maintaining similar data quality. Magn Reson Med 75:196–206, 2016. © 2015 Wiley Periodicals, Inc.

4D UTE flow: A phase-contrast MRI technique for assessment and visualization of stenotic flows

Inaccuracy of conventional four-dimensional (4D) flow MR imaging in the presence of random unsteady and turbulent blood flow distal to a narrowing has been an important challenge. Previous investigations have revealed that shorter echo times (TE) decrease the errors, leading to more accurate flow assessments. In this study, as part of a 4D flow acquisition, an Ultra-Short TE (UTE) method was adopted. UTE works based on a center-out radial k-space trajectory that inherently has a short TE. By employing free induction decay sampling starting from read-out gradient ramp-up, and by combining the refocusing lobe of the slice select gradient with the bipolar flow encoding gradient, TEs of ≈1 msec may be achieved. Both steady and pulsatile flow regimes, and in each case a range of Reynolds numbers, were studied in an in-vitro model. Flow assessment at low and medium flow rates demonstrated a good agreement between 4D UTE and conventional 4D flow techniques. However, 4D UTE flow significantly outperformed conventional 4D flow, at high flow rates for both steady and pulsatile flow regimes. Feasibility of the method in one patient with Aortic Stenosis was also demonstrated. For both steady and pulsatile high flow rates, the measured flow distal to the stenotic narrowing using conventional 4D flow revealed more than 20% error compared to the ground-truth flow. This error was reduced to less than 5% using the 4D UTE flow technique.