Who Needs Hemodynamic Cath When We Have MR 4D Flow?
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1 Who Needs Hemodynamic Cath When We Have MR 4D Flow? Michael Markl, Ph.D. Departments of Radiology & Biomedical Engineering Northwestern University, Chicago, IL, USA October 2016
2 Disclosures Research Support for Northwestern Cardiovascular Imaging Program: Siemens Consultant: Circle Cardiovascular Imaging Inc.
3 Cardiovascular MRI Imaging of Blood Flow 2D Phase-Contrast (PC) MRI ECG synchronized Anatomy and pulsatile blood flow Aorta, 3D CE-MRA Anatomy Flow y x Flow, z
4 Cardiovascular MRI Imaging of Blood Flow Flow Quantification Net flow, cardiac output Regurgitation, valve function, peak velocity, etc.
5 Methods Full Volumetric Coverage: 3D & 3-directional blood flow resolution ~ (2mm) 3 & ~ 40ms FOV 320 x 320 x 64mm velocity encoding: 4TR ~ 20ms 2560 RR intervals, respiration control ~40-80 min total scan time
6 4D Flow MRI Methods In-vivo 3D Blood Flow Res. ~ 2mm 3, T Res ~ 40ms, T Acq ~ 5-15min > 2k-10k images 4D (3D volume + time) flow (3-dir. velocity encoding) MRI
7 Aortic Hemodynamics Bicuspid aortic valve Allen BD, at al. Eur Heart J Cardiovasc Imaging. 2013;14:399
8 Aortic Hemodynamics Patient: 54-yo, bicuspid aortic valve with severe aortic valve stenosis Peak Vel 4.1 msec; AV 1.1 cm 2
9 Aortic Hemodynamics Multiplane PWV(m/s): 3.51
10 Analysis Workflow Peak Velocity MIPs Study in n=51 pediatric BAV patients: 4D flow vs. 2D PC Rose M et al. J Magn Reson Imaging. 2016, published online
11 Pressure Mapping Patient: Coarctation & post-stenotic dilatation Bock J, et al. Magn Reson Med 2011;66:
12 New Hemodynamic Biomarkers Quantification & Biomechanical Modeling Wall shear stress 1-5 Pressure difference mapping 6-8 Turbulence & turbulent kinetic energy 9,10 Pulse wave velocity & vessel elasticity Stalder AF, et al. Magn Reson Med 2008;60(5): Oshinski JN, et al. J Magn Reson Imaging 1995;5(6): Oyre S, et al. Eur J Vasc Endovasc Surg 1998;16(6): Harloff A, et al. Magn Reson Med. 2010;63(6): Frydrychowicz A et al. J Magn Reson Imaging. 2009;30(1): Ebbers T, et al. Biomech Eng 2002;124(3): Tyszka JM, et al. J Magn Reson Imaging 2000;12(2): Bock J, et al. Magn Reson Med 2011;66(4): Dyverfeldt P, et al. Magn Reson Med 2006;56(4): Stalder A.F. et al. J Magn Reson Imaging 2011; 33: Laffon E, et al. J Magn Reson Imaging 2005;21(1): Markl M, et al. Magn Reson Med 2010;63(6): Peng HH, et al. J Magn Reson Imaging 2006;24(6): Vulliemoz S, et al. Magn Reson Med 2002;47(4): Hardy CJ, et al. Magn Reson Med 1994;31(5):
13 BAV Phenotypes RL fusion RN fusion Flow jet right anterior wall 'type 2' tubular aortopathy Flow jet right posterior wall 'type 3' tubular/arch aortopathy Mahadevia R et al. Circulation 2014: Kang JW et al. JACC Cardiovasc Imaging. 2013;6: Verma & Siu. NEJM 2014:
14 BAV Phenotypes BAV Fusion: Impact on flow pattrens & aortopathy phenotype type 2 in 87% type 1 & 3 in 87% TAV control RL fusion RN fusion n = 30 n = 15 n = 15 Mahadevia R, et al. Circulation 2014;129: Barker AJ et al. Circ Cardiovasc Imaging 2012;5(4): Bissell MM et al. Circ Cardiovasc Imaging 2013;6: Meierhofer et al. Eur Heart J Cardiovasc Imaging. 2013;14: Hope MD, et al. Radiology 2010;255:53-61
15 Wall Shear Stress Drag force of blood on aortic wall Regulates endothelial cell function normal WSS abnormal WSS bovine aortic endothelial cells Stalder AF, et al. MRM 2008;60(5): Malek et al. JAMA 1999;282: Mechanistic Link: Altered flow aortic remodeling & dilatation
16 BAV & Wall Tissue Degeneration 4D flow MRI in BAV patient Atlas based WSS heatmap Aorta wall histopathology Hypothesis: Changes in aortic WSS are directly associated with aortic wall degeneration in BAV aortopathy Guzzardi DG et al. J Am Coll Cardiol 2015;66:
17 BAV & Wall Tissue Degeneration Pre-operative 4D flow MRI & wall tissue samples (n=20) Guzzardi DG et al. J Am Coll Cardiol 2015;66:
18 CV-MRI Structure-Function Relationships HCM: Cause of aortic flow disturbance & elevated LVOT pressure Allen BD, et al. Eur Heart J Cardiovasc Imaging. 2015;16:29-36
![T1-Map T1 [ms] Pre & post Gd-contrast T1](/docs-images/75/72969426/images/19-2.jpg "Extracellular volume fraction (ECV) regional LV")
19 CV-MRI Structure-Function Relationships T1-Mapping: Data reconstruction pipeline IR prepared single shot truefisp images Motion correction Inline T1 and error map generation T1-Map T1 [ms] Pre & post Gd-contrast T1 Extracellular volume fraction (ECV) regional LV fibrosis 1 Messroghli et al. Magn Reson Med Kellman et al. Magn Reson Med Xue et al. Magn Reson Med Kellman et al. JCMR 2013
20 CV-MRI Structure-Function Relationships HCM Patient Study, n=23 T1-mapping: Extracellular volume fraction (fibrosis) 4D low MRI: LVOT pressure gradient & energy loss Association pressure gradient / energy loss with LV fibrosis van Ooij P, at al. J Magn Reson Imaging. 2016;43:
21 Analysis Workflow Integration of Other Modalities 3D Printing 55 year old patient type-b dissection Alex Barker, Rouzbeh Ahmadian Northwestern University
22 Applications Carotid arteries Portal vein
23 Acknowledgements Northwestern University, Chicago, USA Radiology / CTI Cardiovascular Imaging James Carr Jeremy Collins Alex Barker Susanne Schnell Kai Lin Emilie Bollache Kelly Jarvis Lingzi Tashakkor Amir Rahsepar Ryan Dolan Julia Geiger Bradley Allen Ozair Rahman Kenichiro Suwa Monica Korrell Julie Blaisdell Rachel Davids Becky Ditch Marisol Bello Alex Hong Xin Chen Travis DeSa Liliana Ma Maria Aristova Cardiology James Thomas Dan Lee Jason Ng Robert Bonow Preeti Kansal Sanjiv Shah Clyde Yancy Alan Anderson Keith Benzuli Ben Freed Jyothy Puthumana Jane Wilcox Cardiac Surgery Chris Malaisrie Patrick McCarthy Pediatric Radiology & Cardiology Cynthia Rigsby Michael Rose Joshua Robinson Neurology / Neurosurgery / Neuroradiology Sameer Ansari Shyam Prabhakaran Ali Shaibani Siemens MR Christianne Leidecker Kelvin Chow Jianing Pang Shivraman Giri Who Needs Hemodynamic Cath When We Have MR 4D Flow? Michael Markl, Ph.D. Departments of Radiology & Biomedical Engineering Northwestern University, Chicago, IL, USA Funding NIH - R01 HL NIH - R01 HL NIH - R21 HL NIH - K25 HL AHA - scientist development grant AHA - pre/postdoc fellowships McCormick Catalyst Award
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