Zia Mehmood, Hosamadin Assadi, Ciaran Grafton-Clarke, Rui Li, Gareth Matthews, Samer Alabed, Rebekah Girling, Victoria Underwood, Bahman Kasmai, Xiaodan Zhao, Fabrizio Ricci, Liang Zhong, Nay Aung, Steffen Erhard Petersen, Andrew J Swift, Vassilios S Vassiliou, João Cavalcante, Rob J van der Geest, Pankaj Garg
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A PC through-plane generated by 4D flow data was treated as a 2D PC plane and compared with the original 4D flow. Visual assessment of flow vectors was used to assess helicity and vorticity. We quantified flow displacement (FD), systolic flow reversal ratio (sFRR) and rotational angle (RA) using 2D PC.</p><p><strong>Results: </strong>For visual vortex flow presence near the inner curvature of the ascending aortic root on 4D flow CMR, sFRR demonstrated an area under the curve (AUC) of 0.955, p<0.001. A threshold of >8% for sFRR had a sensitivity of 82% and specificity of 100% for visual vortex presence. In addition, the average late systolic FD, a marker of flow eccentricity, also demonstrated an AUC of 0.909, p<0.001 for visual vortex flow. Manual systolic rotational flow angle change (ΔsRA) demonstrated excellent association with semiautomated ΔsRA (r=0.99, 95% CI 0.9907 to 0.999, p<0.001). In reproducibility testing, average systolic FD (FDsavg) showed a minimal bias at 1.28% with a high intraclass correlation coefficient (ICC=0.92). Similarly, sFRR had a minimal bias of 1.14% with an ICC of 0.96. ΔsRA demonstrated an acceptable bias of 5.72°-and an ICC of 0.99.</p><p><strong>Conclusion: </strong>2D PC flow imaging can possibly quantify blood flow helicity (ΔRA) and vorticity (FRR). 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引用次数: 0
摘要
目的：本研究的主要目的是开发二维（2D）相位对比（PC）方法，以量化主动脉根部血流的螺旋度和涡度：这项概念验证研究使用了五名健康对照组、五名射血分数保留型心力衰竭患者和五名主动脉瓣狭窄（AS）患者的四维（4D）血流心血管磁共振（4D flow CMR）数据。由四维血流数据生成的 PC 通平面被视为二维 PC 平面，并与原始四维血流进行比较。对血流矢量的目测用于评估螺旋度和涡度。我们使用二维 PC 对流动位移（FD）、收缩流动反向比（sFRR）和旋转角（RA）进行了量化：结果：对于 4D 血流 CMR 上升主动脉根部内弯附近的可视涡流，sFRR 的曲线下面积（AUC）为 0.955，p8%，sFRR 对可视涡流存在的敏感性为 82%，特异性为 100%。结论：二维 PC 血流成像可量化血流螺旋度（ΔRA）和涡度（FRR）。这些血流螺旋度和涡度成像生物标志物具有很高的可重复性，可供临床采用：试验注册号：NCT05114785。
Validation of 2D flow MRI for helical and vortical flows.
Purpose: The main objective of this study was to develop two-dimensional (2D) phase contrast (PC) methods to quantify the helicity and vorticity of blood flow in the aortic root.
Methods: This proof-of-concept study used four-dimensional (4D) flow cardiovascular MR (4D flow CMR) data of five healthy controls, five patients with heart failure with preserved ejection fraction and five patients with aortic stenosis (AS). A PC through-plane generated by 4D flow data was treated as a 2D PC plane and compared with the original 4D flow. Visual assessment of flow vectors was used to assess helicity and vorticity. We quantified flow displacement (FD), systolic flow reversal ratio (sFRR) and rotational angle (RA) using 2D PC.
Results: For visual vortex flow presence near the inner curvature of the ascending aortic root on 4D flow CMR, sFRR demonstrated an area under the curve (AUC) of 0.955, p<0.001. A threshold of >8% for sFRR had a sensitivity of 82% and specificity of 100% for visual vortex presence. In addition, the average late systolic FD, a marker of flow eccentricity, also demonstrated an AUC of 0.909, p<0.001 for visual vortex flow. Manual systolic rotational flow angle change (ΔsRA) demonstrated excellent association with semiautomated ΔsRA (r=0.99, 95% CI 0.9907 to 0.999, p<0.001). In reproducibility testing, average systolic FD (FDsavg) showed a minimal bias at 1.28% with a high intraclass correlation coefficient (ICC=0.92). Similarly, sFRR had a minimal bias of 1.14% with an ICC of 0.96. ΔsRA demonstrated an acceptable bias of 5.72°-and an ICC of 0.99.
Conclusion: 2D PC flow imaging can possibly quantify blood flow helicity (ΔRA) and vorticity (FRR). These imaging biomarkers of flow helicity and vorticity demonstrate high reproducibility for clinical adoption.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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