Flow Magnetic Resonance Research Articles

Computational modeling of MR flow imaging by the lattice Boltzmann method and Bloch equation

In this work, a computational model of magnetic resonance (MR) flow imaging is proposed. The first model component provides fluid dynamics maps by applying the lattice Boltzmann method. The second one uses the flow maps and couples MR imaging (MRI) modeling with a new magnetization transport algorithm based on the Eulerian coordinate approach. MRI modeling is based on the discrete time solution of the Bloch equation by analytical local magnetization transformations (exponential scaling and rotations).Model is validated by comparison of experimental and simulated MR images in two three-dimensional geometries (straight and U-bend tubes) with steady flow under comparable conditions. Two-dimensional geometries, presented in literature, were also tested. In both cases, a good agreement is observed. Quantitative analysis shows in detail the model accuracy. Computational time is noticeably lower to prior works.These results demonstrate that the discrete time solution of Bloch equation coupled with the new magnetization transport algorithm naturally incorporates flow influence in MRI modeling. As a result, in the proposed model, no additional mechanism (unlike in prior works) is needed to consider flow artifacts, which implies its easy extensibility. In combination with its low computational complexity and efficient implementation, the model could have a potential application in study of flow disturbances (in MRI) in various conditions and in different geometries.

Clinical Applications of Aortic 4D Flow Imaging

Quantitative aortic magnetic resonance (MR) blood flow imaging is a rapidly advancing technique that is likely to impact clinical medicine in the near future. The acquisition of comprehensive 4D velocity datasets is now possible in a clinically acceptable time frame. Unique and intuitive visualization methods are available. A number of important hemodynamic biomarkers can be derived from the data, and exploited to help understand how abnormal flow is inter-related with aortic pathology. Initial data suggest that some of the derived biomarkers can refine the clinical assessment of aortic disease and predict disease progression. We provide an overview of aortic imaging with emphasis on how flow imaging is currently used, discuss the fundamental technical aspects of multidimensional MR flow imaging, introduce key hemodynamic markers, and show how this type of imaging may soon be used for the early identification of patients at risk for the development of potentially devastating aortic complications.

Caval Blood Flow Distribution in Patients with Fontan Circulation: Quantification by Using Particle Traces from 4D Flow MR Imaging

To validate the use of particle traces derived from four-dimensional (4D) flow magnetic resonance (MR) imaging to quantify in vivo the caval flow contribution to the pulmonary arteries (PAs) in patients who had been treated with the Fontan procedure. The institutional review boards approved this study, and informed consent was obtained. Twelve healthy volunteers and 10 patients with Fontan circulation were evaluated. The particle trace method consists of creating a region of interest (ROI) on a blood vessel, which is used to emit particles with a temporal resolution of approximately 40 msec. The flow distribution, as a percentage, is then estimated by counting the particles arriving to different ROIs. To validate this method, two independent observers used particle traces to calculate the flow contribution of the PA to its branches in volunteers and compared it with the contribution estimated by measuring net forward flow volume (reference method). After the method was validated, caval flow contributions were quantified in patients. Statistical analysis was performed with nonparametric tests and Bland-Altman plots. P < .05 was considered to indicate a significant difference. Estimation of flow contributions by using particle traces was equivalent to estimation by using the reference method. Mean flow contribution of the PA to the right PA in volunteers was 54% ± 3 (standard deviation) with the reference method versus 54% ± 3 with the particle trace method for observer 1 (P = .4) and 54% ± 4 versus 54% ± 4 for observer 2 (P = .6). In patients with Fontan circulation, 87% ± 13 of the superior vena cava blood flowed to the right PA (range, 63%-100%), whereas 55% ± 19 of the inferior vena cava blood flowed to the left PA (range, 22%-82%). Particle traces derived from 4D flow MR imaging enable in vivo quantification of the caval flow distribution to the PAs in patients with Fontan circulation. This method might allow the identification of patients at risk of developing complications secondary to uneven flow distribution. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120778/-/DC1.

Design, construction, and evaluation of a dynamic MR compatible cardiac left ventricle model

Development of magnetic resonance (MR) sequences is important to answer clinical questions and to overcome current limitations. To meet the challenges of cardiac MR, dynamic and reproducible testing conditions are required. We aimed at developing a dynamic MR-compatible cardiac left ventricle model that imitates myocardial tissue properties and simulates dynamic motion. A dynamic left ventricle silicone model was designed to match myocardial T(1) and T(2) relaxation times. Silicone mixtures were explored to replicate T(2) values of myocardial edema. A controllable piston pump was constructed to produce pulsatile flow paradigms. They were validated against flow sensors and MR data, including SSFP-based and phase-contrast-based sequences. A dedicated software interface was developed for the control. Model dimensions represented cardiac left ventricle dimensions of healthy men. The range of end diastolic volumes was 85-175 ml, depending on the driven stroke volume. Stroke volume quantification for flow paradigms of 30∕60∕90∕120 ml resulted in 29.2∕57.6∕88.8∕118.4 ml by MR volumetry, 29.6∕59.9∕89.4∕119.0 ml by phase contrast measurements, and 29.9∕60.4∕91.1∕120.9 ml by flow meter revealing consistency. The system accurately replicated physiological and pathophysiological flow paradigms. The silicon model exhibited T(1) of 1002 ± 8 ms, T(2) of 58 ± 1 ms. Signal intensities (a.u.) of the ventricle model were 128 ± 23 for FGRE (vs 138 ± 17 in vivo) and 1156 ± 37 for b-SSFP (vs 991 ± 96 in vivo). T(2) of 75 ± 2 ms was achieved for the myocardial pathology. We developed a controllable left ventricle model resembling MR signal characteristics of human myocardium, including pathological conditions, and allowing for the replication of contraction and flow paradigms.

Short-term effects of tolvaptan on renal function and volume in patients with autosomal dominant polycystic kidney disease

Tolvaptan and related V(2)-specific vasopressin receptor antagonists have been shown to delay disease progression in animal models of polycystic kidney disease. Slight elevations in serum creatinine, rapidly reversible after drug cessation, have been found in clinical trials involving tolvaptan. Here, we sought to clarify the potential renal mechanisms to see whether the antagonist effects were dependent on underlying renal function in 20 patients with autosomal dominant polycystic kidney disease (ADPKD) before and after 1 week of daily split-dose treatment. Tolvaptan induced aquaresis (excretion of solute-free water) and a significant reduction in glomerular filtration rate (GFR). The serum uric acid increased because of a decreased uric acid clearance, and the serum potassium fell, but there was no significant change in renal blood flow as measured by para-aminohippurate clearance or magnetic resonance imaging (MRI). No correlation was found between baseline GFR, measured by iothalmate clearance, and percent change in GFR induced by tolvaptan. Blinded post hoc analysis of renal MRIs showed that tolvaptan significantly reduced total kidney volume by 3.1% and individual cyst volume by 1.6%. Preliminary analysis of this small cohort suggested that these effects were more noticeable in patients with preserved renal function and with larger cysts. No correlation was found between changes of total kidney volume and body weight or estimated body water. Thus, functional and structural effects of tolvaptan on patients with ADPKD are likely due to inhibition of V(2)-driven adenosine cyclic 3',5'-monophosphate generation and its aquaretic, hemodynamic, and anti-secretory actions.

Comparison of arterial and venous coronary artery bypass flow measurements using 3-T magnetic resonance phase contrast imaging

Comparison of arterial and venous coronary artery bypass flow measurements using 3-T magnetic resonance (MR) phase contrast in correlation with intraoperative Doppler flow measurements. Fifty-six coronary bypasses (right coronary artery n=18, left internal mammary artery to left anterior descending artery n=16, marginal artery n=7, circumflex artery n=7, diagonal artery n=6, left anterior descending artery n=1, and right internal mammary artery to right coronary artery n=1) were studied in 27 asymptomatic patients. In this prospective study, each bypass was studied intra-operatively using Doppler flow measurement. Within one week post surgery, patients were studied using a 3-T MR scanner (Magnetom Verio, Siemens, Erlangen, Germany) using velocity encoded phase-contrast flow measurements. Intraoperative Doppler flow measurements demonstrated regular flow patterns in all vascular territories supplied. All bypasses were patent on MRI and flow measurement results were as follows: median flow 60ml/min (interquartile range (IQR): 37.5-78.5ml/min). For comparison, the corresponding median intraoperative flow was 58ml/min (IQR: 41-80ml/min) (p<0.001; R=0.44). Linear regression analysis demonstrated a significant correlation for venous bypasses (p=0.0002; R=0.48), but not for arterial bypasses (p=0.09; R=0.24). This study demonstrated that MR flow measurements of venous bypass grafts agreed more with Doppler than arterial bypass grafts. However, bypass patency was confirmed for all patients. In the future, this technique may be used for non invasive coronary bypass graft follow-up.

Influence of slice thickness on MR flow quantification in turbulent jets

Magnetic Resonance (MR) based flow quantification is of high interest in several cardiac diseases, e.g. valvular stenosis. However, accurate results remain challenging in several conditions. Recently, some contributors could be defined including echo time [1] (TE) and background phase errors [2]. We investigated the influence of slice thickness on flow quantification in turbulent flow.

Bicuspid Aortic Valve: Four-dimensional MR Evaluation of Ascending Aortic Systolic Flow Patterns

To use time-resolved three-dimensional phase-contrast magnetic resonance (MR) imaging, also called four-dimensional flow MR imaging, to evaluate systolic blood flow patterns in the ascending aorta that may predispose patients with a bicuspid aortic valve (BAV) to aneurysm. The HIPAA-compliant protocol received institutional review board approval, and informed consent was obtained. Four-dimensional flow MR imaging was used to assess blood flow in the thoracic aorta of 53 individuals: 20 patients with a BAV, 25 patients with a tricuspid aortic valve (TAV), and eight healthy volunteers. The Fisher exact test was used to evaluate the significance of flow pattern differences. Nested helical flow was seen at peak systole in the ascending aorta of 15 of 20 patients with a BAV but in none of the healthy volunteers or patients with a TAV. This flow pattern was seen both in patients with a BAV with a dilated ascending aorta (n = 6) and in those with a normal ascending aorta (n = 9), was seen in the absence of aortic stenosis (n = 5), and was associated with eccentric systolic flow jets in all cases. Fusion of right and left leaflets gave rise to right-handed helical flow and right-anterior flow jets (n = 11), whereas right and noncoronary fusion gave rise to left-handed helical flow with left-posterior flow jets (n = 4). Four-dimensional flow MR imaging showed abnormal helical systolic flow in the ascending aorta of patients with a BAV, including those without aneurysm or aortic stenosis. Identification and characterization of eccentric flow jets in these patients may help identify those at risk for development of ascending aortic aneurysm.

Spatial factors for quantifying constant flow velocity in a small tube phantom: comparison of phase-contrast cine-magnetic resonance imaging and the intraluminal Doppler guidewire method

We examined the spatial factors influencing magnetic resonance (MR) flow velocity measurements in a small tube phantom and used the same measurements obtained with an intraluminal Doppler guidewire as reference. We generated constant flow velocities from approximately 40 to 370 cm/s in a tube 4 mm in diameter. We then performed segmented k-space, phase-contrast cine-MR imaging to quantify spatial peak flow velocities of one pixel and of five adjacent pixels as well as spatial mean velocities within regions of interest in a cross section of the phantom. Pixel dimensions ranged from 1.00 x 1.00 mm to 2.50 x 2.50 mm. We compared the MR measurements with the temporally averaged Doppler spectral peak velocities. For one pixel (r > 0.99: MR flow velocity for pixel dimension 1.00 x 1.00 mm = 1.03x + 9.8 cm/s), the linear correlation was excellent between flow velocities by MR and Doppler guidewire methods. However, for the five adjacent pixels, MR measurements were significantly underestimated using pixels 1.25 x 1.25 mm to 2.50 x 2.50 mm and for mean velocities for all pixel dimensions. Relatively high spatial resolution allows accurate MR measurement of constant flow velocity in a small tube at spatial peak velocities for one pixel.

Idiopathic Syringomyelia: Phase-Contrast MR of Cerebrospinal Fluid Flow Dynamics at Level of Foramen Magnum

To measure cerebrospinal fluid (CSF) flow velocities in the foramen magnum in patients with idiopathic syringomyelia (IS). Patient consent for this retrospective study was waived by the institutional review board within the guidelines of HIPAA. The authors reviewed the medical records of a neurosurgery specialty clinic to identify patients with IS-that is, syringomyelia without evidence of Chiari malformation, tumor, or substantial spine trauma. Patients without syringomyelia or Chiari malformation identified from the review served as control subjects. The data of patients and control subjects who had undergone phase-contrast magnetic resonance (MR) imaging were included in the study. MR flow images were inspected for evidence of synchronous bidirectional CSF flow and heterogeneous spatial and temporal flow patterns. Peak CSF flow velocities in the IS and control groups were calculated, and differences were tested for statistical significance by using the Wilcoxon rank sum test. Eight patients who met the criteria for IS and six who met the criteria to serve as control subjects were identified. The phase-contrast MR images obtained in five of the eight patients with IS and in none of the control subjects depicted synchronous bidirectional flow and/or large flow jets. Mean peak systolic (caudal) CSF flow velocities were 6.7 cm/sec in the IS group and 3.6 cm/sec in the control group; the difference was significant (P < .01). Mean peak diastolic (cephalic) velocities were 3.9 and 3.4 cm/sec in the IS and control groups, respectively; the difference was not significant (P = .36). Some patients with IS have increased peak systolic CSF flow velocities.

MR imaging of aortic coarctation

Aortic coarctation accounts for 5%-10% of all congenital heart diseases and represents 7% of critically ill infants with heart disease. Magnetic resonance (MR) imaging allows the study of this disease with several advantages in comparison with conventional angiography, transesophageal echocardiography, and computed tomography. The MR protocol applied at our institution for both diagnosis and follow-up after surgical or endovascular treatment consists of four steps: morphologic study, cine MR study, flow analysis, and MR angiography (MRA). The first three sequences are acquired during breath-hold and with electrocardiographic gating. Anatomy is well depicted with dark-blood half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. Cine true-fast imaging with steady-state precession (true-FISP) sequences show not only morphologic features but also blood-flow changes inside the aorta. Gradient-echo sequences for phase-velocity mapping allow flow analysis. Application of Bernoulli's equation--here briefly presented and discussed--allows for calculation of the pressure gradient caused by the coarctation. MRA, acquired with a breath-hold three-dimensional T1-weighted gradient-echo sequence and intravenous administration of paramagnetic contrast material, allows for optimal depiction of the aortic lumen, with a panoramic view of the whole aorta, its main branches and possible collateral circulation.

Detection of Cell Death in Tumors by Using MR Imaging and a Gadolinium-based Targeted Contrast Agent

To prospectively determine in an animal model whether an ionic gadolinium (Gd(3+)) chelate conjugate of the C2A domain of synaptotagmin I can be used with magnetic resonance (MR) imaging to detect tumor cell death noninvasively in vivo. Animal experiments were approved by a local ethics review committee. Gd(3+) chelates and fluorescent probes were attached to the lysine epsilon-amino groups of a glutathione-S-transferase-C2A fusion protein. Binding to phosphatidylserine (PS) was characterized by using surface plasmon resonance, and binding to dying cells in vitro was characterized by using flow cytometry and MR imaging. Binding to dying tumor cells in vivo was detected with T1 mapping and T1-weighted MR imaging and compared in drug-treated animals (n = 10); in animals injected with a site-directed mutant, which was inactive in PS binding (PS inactive) and which showed lesser binding to dying cells (n = 6); and in untreated animals injected with PS-active (n = 6) and PS-inactive (n = 6) contrast agents. Among groups, differences that were significant were analyzed by using analysis of variance and Dunnett post hoc analysis. The contrast agent had a relatively high affinity for PS (dissociation constant = 333 nmol/L +/- 85 [mean +/- standard error of the mean]; n = 3) and bound to apoptotic and necrotic, but not viable, cells in vitro. There was a greater tumor accumulation of the PS-active contrast agent compared with the PS-inactive contrast agent in drug-treated animals (P < .05) and compared with untreated animals injected with the PS-active and PS-inactive contrast agents (P < .01 for both). A relatively small (approximately 100 kDa) Gd(3+)-based contrast agent, which gives positive contrast on MR images, can be used to detect tumor cell death in vivo, and future derivatives of it may be used to assess early tumor responses to treatment.

Dynamic cervicomedullary cord compression and alterations in cerebrospinal fluid dynamics in children with achondroplasia

Achondroplasia is the most common of the heritable skeletal dysplasias. Compression at the cervicomedullary junction can result in myelopathy, hypotonia, sleep apnea, and even sudden death. However, most children with achondroplasia do not suffer from severe neurological symptoms and achieve normal motor and intellectual development without surgical intervention. At the authors' institution, magnetic resonance (MR) imaging and cerebrospinal fluid (CSF) flow studies have been incorporated in the assessment of children with achondroplasia for cervicomedullary junction compression. The authors recently identified four children with achondroplasia who had normal findings on MR imaging and flow studies obtained in the neutral position. On flexion studies, however, three had complete blockage of CSF flow, and more dramatic posterior cervicomedullary compression was demonstrated on extension studies. Some of these patients had severe neurological abnormalities and sleep apnea, while others just developed headaches and/or had apnea episodes when sleeping or in a car seat. Three children underwent decompressive surgery with dramatic improvement or resolution of signs and symptoms. The fourth patient had increased CSF pressure on MR images obtained in the flexed position, possibly due to venous outflow obstruction. Her condition improved dramatically after placement of a ventriculoperitoneal shunt. The increased risk of dynamic cord compression and alterations in CSF dynamics in patients with achondroplasia constitute indications for surgical intervention.

Evaluation of a resistance‐based model for the quantification of pulmonary arterial hypertension using MR flow measurements

To establish an estimate for the mean pulmonary arterial pressure (mPAP) derived from noninvasive data acquired with magnetic resonance (MR) velocity-encoded sequences. In seven sedated pigs synchronous catheter-based invasive pressure measurements (IPM) and noninvasive MR were acquired in the main pulmonary artery (MPA) at different severities of pulmonary arterial hypertension (PAH) that were caused by infusion of thromboxane A2 (TxA2). The invasively measured mPAP was correlated with the noninvasive MR velocity data and linear combination equations (LCE) were computed. Intravenously applied TxA2 induced a dose dependent level of severity of PAH with an mPAP of up to 54 mmHg without systemic effects. The acceleration time (AT) measured with MR demonstrated the best correlation with the mPAP (r(2) = 0.75). The LCE with the highest correlation (R = 0.945, alpha < 0.01) between IPM and MR revealed a mean difference of 0, a SD of s = 4.66 and a maximal difference of 12.2 mmHg using the Bland-Altman analysis. Applying the identified LCE allowed the estimation of the mPAP in an acute and resistance-based model of PAH with high accuracy using noninvasive MR velocity-encoded sequences.

Correlation of femoral artery flow velocity waveform with ipsilateral iliac artery stenoses assessed with magnetic resonance imaging

Magnetic resonance (MR) permits quantitative flow velocity measurements that could be used to detect changes in the curve profile downstream of a high-grade stenosis. To assess whether MR flow measurements can be used to detect iliac artery stenoses. Contrast-enhanced magnetic resonance angiography (MRA) and quantitative flow measurements in the lower aorta and proximal femoral arteries were performed in 29 patients with suspected iliac artery stenoses. Stenoses were graded into five degrees: 0%, 1-49%, 50-74%, 75-99%, and 100% diameter reduction. The femoral artery waveforms were evaluated qualitatively by two independent reviewers regarding peak systolic velocity (PSV), aortofemoral difference in time-to-peak (DeltaTTP), systolic acceleration (SA), curve-shape index (CSI), and the presence of an early diastolic flow reversal. The correlation between these parameters and the degree of stenosis was assessed. A significant correlation with degree of stenosis was observed for the qualitative flow waveform evaluations, with a high degree of interobserver agreement (kappa = 0.84). A significant correlation was also found between degree of stenosis and PSV, DeltaTTP, SA, CSI, and presence of diastolic flow reversal. The flow velocity pattern, however, remained unchanged, both qualitatively and quantitatively, up to a stenosis degree of at least 75%. Iliac artery stenoses cause femoral artery flow waveform changes that can be detected with MRI, but only at high-grade levels.

Functional magnetic resonance imaging in renal artery stenosis

Renal artery stenosis (RAS) is the leading cause of secondary hypertension. Magnetic resonance (MR) imaging and in particular MR angiography have evolved into important diagnostic tools for the detection and grading of RAS due to the lack of ionizing radiation and nephrotoxic contrast agent. This review describes state-of-the-art MR angiographic techniques and introduces the reader to current concepts of RAS grading with MR angiography. We compare MR angiography with conventional angiography and intravascular ultrasound as a standard of reference. The technical basis of functional imaging techniques such as arterial spin labeling perfusion measurements, contrast-enhanced perfusion measurements, and MR flow measurements are explained. Their value for the grading and detection of RAS and for the differentiation of renovascular from renal parenchymal disease is discussed. An overview about imaging during and after interventional therapy of RAS and an introduction to the current understanding of prediction of successful interventional therapy finishes this review.

Measurement of total pulmonary arterial compliance using invasive pressure monitoring and MR flow quantification during MR-guided cardiac catheterization

Pulmonary hypertensive disease is assessed by quantification of pulmonary vascular resistance. Pulmonary total arterial compliance is also an indicator of pulmonary hypertensive disease. However, because of difficulties in measuring compliance, it is rarely used. We describe a method of measuring pulmonary arterial compliance utilizing magnetic resonance (MR) flow data and invasive pressure measurements. Seventeen patients with suspected pulmonary hypertension or congenital heart disease requiring preoperative assessment underwent MR-guided cardiac catheterization. Invasive manometry was used to measure pulmonary arterial pressure, and phase-contrast MR was used to measure flow at baseline and at 20 ppm nitric oxide (NO). Total arterial compliance was calculated using the pulse pressure method (parameter optimization of the 2-element windkessel model) and the ratio of stroke volume to pulse pressure. There was good agreement between the two estimates of compliance (r = 0.98, P < 0.001). However, there was a systematic bias between the ratio of stroke volume to pulse pressure and the pulse pressure method (bias = 61%, upper level of agreement = 84%, lower level of agreement = 38%). In response to 20 ppm NO, there was a statistically significant fall in resistance, systolic pressure, and pulse pressure. In seven patients, total arterial compliance increased >10% in response to 20 ppm NO. As a population, the increase did not reach statistical significance. There was an inverse relation between compliance and resistance (r = 0.89, P < 0.001) and between compliance and mean pulmonary arterial pressure (r = 0.72, P < 0.001). We have demonstrated the feasibility of quantifying total arterial compliance using an MR method.

Anteil des frühen systolischen Flussanstiegs am antegrad fließenden Gesamtvolumen bei Phasenkontrast-Flussmessungen in Atemanhaltetechnik

Purpose: To evaluate the contribution of early systole for the assessment of antegrade aortic flow volume by breath-hold velocity-encoded magnetic resonance (MR) flow measurements. Materials and Methods: Expiratory breath-hold fast low-angle shot (FLASH) phase-contrast flow measurements (temporal resolution tRes 61 msec, shared phases) perpendicular to the proximal ascending aorta and short axis true fast imaging with steady-state precession (TrueFISP) cine MR ventriculometry (tRes 34.5 msec) were performed in ten healthy male volunteers on a 1.5 T MR system (Sonata, Siemens Medical Solutions). Antegrade aortic flow volume (AFV) and left ventricular stroke volume (LV-SV) were evaluated using Argus Ventricular Function and Argus Flow Software, version MR 2002B (Siemens Medical Solutions). A beta release of Argus Flow MR 2004A allowed interpolation of the flow up-slope during early systole to the preceding R-wave trigger. The respective intraindividual median differences between the AFV of each flow evaluation and LV-SV as well as between both AFV measurements were calculated and compared using the sign test for paired samples. Results: Non-interpolated AFV significantly deviated from LV-SV (p=0.006), underestimating the latter by 13.1 mL (13%). Interpolating aortic flow during early systole significantly increased AFV by 10.8 mL (13 %) compared to the flow evaluation which did not take early systole into account (p = 0.006). AFV with interpolation of early systolic flow agreed well with LV-SV (median difference -3.0mL or -3%, respectively), and no significant difference between these measurements was found (p = 1.0). Conclusion: Flow during early systole contributes substantially to total forward flow volume in the ascending aorta. Interpolation of the early systolic up-slope is therefore recommended for the evaluation of breath-hold phase-contrast flow measurements.

Anteil des frühen systolischen Flussanstiegs am antegrad fließenden Gesamtvolumen bei Phasenkontrast-Flussmessungen in Atemanhaltetechnik

To evaluate the contribution of early systole for the assessment of antegrade aortic flow volume by breath-hold velocity-encoded magnetic resonance (MR) flow measurements. Expiratory breath-hold fast low-angle shot (FLASH) phase-contrast flow measurements (temporal resolution tRes 61 msec, shared phases) perpendicular to the proximal ascending aorta and short axis true fast imaging with steady-state precession (TrueFISP) cine MR ventriculometry (tRes 34.5 msec) were performed in ten healthy male volunteers on a 1.5 T MR system (Sonata, Siemens Medical Solutions). Antegrade aortic flow volume (AFV) and left ventricular stroke volume (LV-SV) were evaluated using Argus Ventricular Function and Argus Flow Software, version MR 2002B (Siemens Medical Solutions). A beta release of Argus Flow MR 2004A allowed interpolation of the flow up-slope during early systole to the preceding R-wave trigger. The respective intraindividual median differences between the AFV of each flow evaluation and LV-SV as well as between both AFV measurements were calculated and compared using the sign test for paired samples. Non-interpolated AFV significantly deviated from LV-SV (p = 0.006), underestimating the latter by 13.1 mL (13 %). Interpolating aortic flow during early systole significantly increased AFV by 10.8 mL (13 %) compared to the flow evaluation which did not take early systole into account (p = 0.006). AFV with interpolation of early systolic flow agreed well with LV-SV (median difference - 3.0 mL or - 3 %, respectively), and no significant difference between these measurements was found (p = 1.0). Flow during early systole contributes substantially to total forward flow volume in the ascending aorta. Interpolation of the early systolic up-slope is therefore recommended for the evaluation of breath-hold phase-contrast flow measurements.

Magnetic resonance measurement of coronary blood flow

Magnetic resonance (MR) flow measurement in the coronary artery can be achieved with either a breath-hold acquisition or a respiration-triggered acquisition. MR measurements of cardiac output are significantly depressed during breath-holding at deep inspiration, but the advantage is that the breath-hold method requires less scan time. Blood flow in the coronary sinus reflects the global myocardial blood flow because it represents approximately 96% of the total myocardial blood flow of the left ventricle (LV). If blood flow in the coronary sinus is measured with phase-contrast cine magnetic resonance imaging (MRI) and LV myocardial mass is measured with cine MRI, both the total myocardial blood flow and the average coronary blood flow per gram of myocardial mass can be quantified. Coronary flow reserve with volumetric MR flow measurement is measured to be within 4.2–5.0-fold. The noninvasive MR measurement of coronary flow reserve has been shown to be useful in identifying the functional significance of stenoses in the left anterior descending artery. The sensitivity and specificity of MR coronary flow velocity reserve for identifying stenosis of 70% or greater in the left main or left anterior descending artery were 100% and 83%, respectively. The MR quantification of total coronary blood flow and coronary blood flow per gram of myocardial mass seems to be an ideal method for evaluating coronary hemodynamics and may be useful in evaluating endothelial dysfunction of the coronary circulation. Summary Recent advances in fast MRI sequences have considerably extended the capabilities of cardiac MRI in the functional assessment of coronary blood flow and flow reserve. The MR measurement of coronary flow reserve can be used to identify restenosis of the left main and left anterior descending coronary arteries after percutaneous interventions in clinical patients. Further refinements in MR pulse sequences, including the use of phase-contrast echo-planar or spiral MR methods, may make it possible to quantify blood flow volume and flow reserve more accurately in all major branches of the coronary arteries. The MR measurement of blood flow through the coronary sinus allows a noninvasive assessment of global coronary hemodynamics. Because the coronary sinus is larger than the native coronary arteries, the errors in blood flow quantification associated with the limited spatial and temporal resolution of current phase-contrast MR sequences are substantially smaller. The MR quantification of total coronary blood flow and coronary blood flow per gram of myocardium during stress and at rest seems to be an ideal method for evaluating coronary hemodynamics in diffuse myocardial diseases of the heart, such as hypertensive heart diseases and cardiomyopathies, and may be useful in evaluating endothelial dysfunction of the coronary circulation, which develops in the earliest stages of atherosclerotic disease and may precede obstruction of the epicardial coronary arteries.