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4D Flow MR: Insights into Aortic Blood Flow Characteristics

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Surgical Management of Aortic Pathology

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Abstract

Imaging of the aorta is mainly done using MR and CT as outlined in other chapters. Both techniques have the advantage of being able to depict intraluminal, intramural, and surrounding pathologies with high spatial resolution and excellent tissue contrast. However, describing the function of the aorta itself as well as the interplay between blood flow and aortic remodeling is challenging. With the advent of a novel MR technique, called 4D flow, new insights into aortic pathophysiology are possible (Markl, Kilner, Ebbers, J Cardiovasc Magn Reson.13:7, 2011).

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References

  1. Markl M, Kilner PJ, Ebbers T. Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:7.

    Article  Google Scholar 

  2. Myerson SG. Heart valve disease: investigation by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:7.

    Article  Google Scholar 

  3. Strecker C, Harloff A, Wallis W, Markl M. Flow-sensitive 4D MRI of the thoracic aorta: comparison of image quality, quantitative flow, and wall parameters at 1.5 T and 3 T. J Magn Reson Imaging. 2012;36:1097–103.

    Article  Google Scholar 

  4. Bock J, Frydrychowicz A, Stalder AF, et al. 4D phase contrast MRI at 3 T: effect of standard and blood-pool contrast agents on SNR, PC-MRA, and blood flow visualization. Magn Reson Med. 2010;63:330–8.

    Article  Google Scholar 

  5. Markl M, Schnell S, Barker AJ. 4D flow imaging: current status to future clinical applications. Curr Cardiol Rep. 2014;16:481.

    Article  Google Scholar 

  6. Lorenz R, Bock J, Barker AJ, et al. 4D flow magnetic resonance imaging in bicuspid aortic valve disease demonstrates altered distribution of aortic blood flow helicity. Magn Reson Med. 2014;71:1542–53.

    Article  CAS  Google Scholar 

  7. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.

    Article  Google Scholar 

  8. Kilner PJ, Yang GZ, Wilkes AJ, Mohiaddin RH, Firmin DN, Yacoub MH. Asymmetric redirection of flow through the heart. Nature. 2000;404:759–61.

    Article  CAS  Google Scholar 

  9. Markl M, Geiger J, Kilner PJ, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of cardiovascular flow paths in volunteers and patients with Fontan circulation. Eur J Cardiothorac Surg. 2011;39:206–12.

    Article  Google Scholar 

  10. Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA. 1999;282:2035–42.

    Article  CAS  Google Scholar 

  11. Frydrychowicz A, Stalder AF, Russe MF, et al. Three-dimensional analysis of segmental wall shear stress in the aorta by flow-sensitive four-dimensional-MRI. J Magn Reson Imaging. 2009;30:77–84.

    Article  Google Scholar 

  12. Barker AJ, Markl M, Burk J, et al. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging. 2012;5:457–66.

    Article  Google Scholar 

  13. Bieging ET, Frydrychowicz A, Wentland A, et al. In vivo three-dimensional MR wall shear stress estimation in ascending aortic dilatation. J Magn Reson Imaging. 2011;33:589–97.

    Article  Google Scholar 

  14. Meierhofer C, Schneider EP, Lyko C, et al. Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study. Eur Heart J Cardiovasc Imaging. 2013;14:797–804.

    Article  Google Scholar 

  15. Burk J, Blanke P, Stankovic Z, et al. Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR. J Cardiovasc Magn Reson. 2012;14:84.

    Article  Google Scholar 

  16. Markl M, Wallis W, Brendecke S, Simon J, Frydrychowicz A, Harloff A. Estimation of global aortic pulse wave velocity by flow-sensitive 4D MRI. Magn Reson Med. 2010;63:1575–82.

    Article  Google Scholar 

  17. Dyverfeldt P, Ebbers T, Lanne T. Pulse wave velocity with 4D flow MRI: systematic differences and age-related regional vascular stiffness. Magn Reson Imaging. 2014;32:1266–71.

    Article  Google Scholar 

  18. Nishimura RA, Otto C. 2014 ACC/AHA valve guidelines: earlier intervention for chronic mitral regurgitation. Heart. 2014;100:905–7.

    Article  Google Scholar 

  19. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv. 2010;76:E43–86.

    Google Scholar 

  20. Wilton E, Jahangiri M. Post-stenotic aortic dilatation. J Cardiothorac Surg. 2006;1:7.

    Article  Google Scholar 

  21. Hope MD, Dyverfeldt P, Acevedo-Bolton G, et al. Post-stenotic dilation: evaluation of ascending aortic dilation with 4D flow MR imaging. Int J Cardiol. 2012;156:e40–2.

    Article  Google Scholar 

  22. van Ooij P, Potters WV, Nederveen AJ, et al. A methodology to detect abnormal relative wall shear stress on the full surface of the thoracic aorta using four-dimensional flow MRI. Magn Reson Med. 2015;73:1216–27.

    Article  Google Scholar 

  23. Dyverfeldt P, Hope MD, Tseng EE, Saloner D. Magnetic resonance measurement of turbulent kinetic energy for the estimation of irreversible pressure loss in aortic stenosis. JACC Cardiovasc Imaging. 2013;6:64–71.

    Article  Google Scholar 

  24. Barker AJ, van Ooij P, Bandi K, et al. Viscous energy loss in the presence of abnormal aortic flow. Magn Reson Med. 2014;72:620–8.

    Article  Google Scholar 

  25. Barker AJ, Markl M. The role of hemodynamics in bicuspid aortic valve disease. Eur J Cardiothorac Surg. 2011;39:805–6.

    Article  Google Scholar 

  26. Bissell MM, Hess AT, Biasiolli L, et al. Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging. 2013;6:499–507.

    Article  Google Scholar 

  27. Hope MD, Wrenn J, Sigovan M, Foster E, Tseng EE, Saloner D. Imaging biomarkers of aortic disease: increased growth rates with eccentric systolic flow. J Am Coll Cardiol. 2012;60:356–7.

    Article  Google Scholar 

  28. Hope MD, Meadows AK, Hope TA, et al. Clinical evaluation of aortic coarctation with 4D flow MR imaging. J Magn Reson Imaging. 2010;31:711–8.

    Article  Google Scholar 

  29. Frydrychowicz A, Markl M, Hirtler D, et al. Aortic hemodynamics in patients with and without repair of aortic coarctation: in vivo analysis by 4D flow-sensitive magnetic resonance imaging. Investig Radiol. 2011;46:317–25.

    Google Scholar 

  30. Riesenkampff E, Fernandes JF, Meier S, et al. Pressure fields by flow-sensitive, 4D, velocity-encoded CMR in patients with aortic coarctation. JACC Cardiovasc Imaging. 2014;7:920–6.

    Article  Google Scholar 

  31. Markl M, Draney MT, Miller DC, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of aortic flow in healthy volunteers and patients after valve-sparing aortic root replacement. J Thorac Cardiovasc Surg. 2005;130:456–63.

    Article  Google Scholar 

  32. Semaan E, Markl M, Malaisrie SC, et al. Haemodynamic outcome at four-dimensional flow magnetic resonance imaging following valve-sparing aortic root replacement with tricuspid and bicuspid valve morphology. Eur J Cardiothorac Surg. 2014;45:818–25.

    Article  Google Scholar 

  33. von Knobelsdorff-Brenkenhoff F, Dieringer MA, Greiser A, Schulz-Menger J. In vitro assessment of heart valve bioprostheses by cardiovascular magnetic resonance: four-dimensional mapping of flow patterns and orifice area planimetry. Eur J Cardiothorac Surg. 2011;40:736–42.

    Google Scholar 

  34. von Knobelsdorff-Brenkenhoff F, Trauzeddel RF, Barker AJ, Gruettner H, Markl M, Schulz-Menger J. Blood flow characteristics in the ascending aorta after aortic valve replacement-a pilot study using 4D-flow MRI. Int J Cardiol. 2014;170:426–33.

    Article  Google Scholar 

  35. Trauzeddel F, Loebe U, Barker A, et al. Blood flow pattern in the ascending aorta after TAVI and conventional aortic valve replacement: analysis using 4D-flow MRI. Int J Cardiovasc Imaging. 2016;32:461–7.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiology, Clinic Agatharied, Academic Teaching Hospital, Ludwig-Maximilians-University Munich, Norbert-Kerkel-Platz, Munich, Germany

    Florian von Knobelsdorff-Brenkenhoff

  2. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Alex J. Barker

Authors
  1. Florian von Knobelsdorff-Brenkenhoff
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  2. Alex J. Barker
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Correspondence to Florian von Knobelsdorff-Brenkenhoff .

Editor information

Editors and Affiliations

  1. Fmr Royal Brompton Hospital, London, UK

    Olaf H. Stanger

  2. Royal Brompton Hospital, London, UK

    John R. Pepper

  3. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Lars G. Svensson

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von Knobelsdorff-Brenkenhoff, F., Barker, A.J. (2019). 4D Flow MR: Insights into Aortic Blood Flow Characteristics. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_28

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  • DOI: https://doi.org/10.1007/978-3-7091-4874-7_28

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-4872-3

  • Online ISBN: 978-3-7091-4874-7

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