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      Evaluation of Elevated Mean Pulmonary Arterial Pressure Based on Magnetic Resonance 4D Velocity Mapping: Comparison of Visualization Techniques

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          Abstract

          Purpose

          Three-dimensional (3D) magnetic resonance phase contrast imaging (PC-MRI) allows non-invasive diagnosis of pulmonary hypertension (PH) and estimation of elevated mean pulmonary arterial pressure (mPAP) based on vortical motion of blood in the main pulmonary artery. The purpose of the present study was to compare the presence and duration of PH-associated vortices derived from different flow visualization techniques with special respect to their performance for non-invasive assessment of elevated mPAP and diagnosis of PH.

          Methods

          Fifty patients with suspected PH (23 patients with and 27 without PH) were investigated by right heart catheterization and time-resolved PC-MRI of the main pulmonary artery. PC-MRI data were visualized with dedicated prototype software, providing 3D vector, multi-planar reformatted (MPR) 2D vector, streamline, and particle trace representation of flow patterns. Persistence of PH-associated vortical blood flow (t vortex) was evaluated with all visualization techniques. Dependencies of t vortex on visualization techniques were analyzed by means of correlation and receiver operating characteristic (ROC) curve analysis.

          Results

          t vortex values from 3D vector visualization correlated strongly with those from other visualization techniques (r = 0.98, 0.98 and 0.97 for MPR, streamline and particle trace visualization, respectively). Areas under ROC curves for diagnosis of PH based on t vortex did not differ significantly and were 0.998 for 3D vector, MPR vector and particle trace visualization and 0.999 for streamline visualization. Correlations between elevated mPAP and t vortex in patients with PH were r = 0.96, 0.93, 0.95 and 0.92 for 3D vector, MPR vector, streamline and particle trace visualization, respectively. Corresponding standard deviations from the linear regression lines ranged between 3 and 4 mmHg.

          Conclusion

          3D vector, MPR vector, streamline as well as particle trace visualization of time-resolved 3D PC-MRI data of the main pulmonary artery can be employed for accurate vortex-based diagnosis of PH and estimation of elevated mPAP.

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          Most cited references17

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          ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association.

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            Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology.

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              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. RSNA, 2010
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                12 December 2013
                : 8
                : 12
                : e82212
                Affiliations
                [1 ]Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
                [2 ]Siemens AG, Healthcare Sector, Graz, Austria
                [3 ]Division of Pulmology, Department of Internal Medicine, Medical University of Graz & LBI for Lung Vascular Research, Graz, Austria
                [4 ]Siemens AG, Healthcare Sector, Erlangen, Germany
                [5 ]Siemens Corporate Research, Baltimore, United States
                University Hospital of Würzburg, Germany
                Author notes

                Competing Interests: GR, AFS, and AG are employed by Siemens Healthcare, MAG is employee of Siemens Medical Cooperate Research. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. All authors have declared that no competing interests exist.

                Conceived and designed the experiments: UR GR GK HO MF. Performed the experiments: UR GR GK. Analyzed the data: UR GR. Contributed reagents/materials/analysis tools: UR GR AFS MAG AG. Wrote the paper: UR GR GK AFS MAG AG HO MF.

                Article
                PONE-D-13-26171
                10.1371/journal.pone.0082212
                3861394
                24349224
                1b749324-cb28-4cef-acfb-c14d349356ac
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 June 2013
                : 22 October 2013
                Page count
                Pages: 9
                Funding
                The project was supported by a grant of the Styrian government (grant number ABT08–16.R-8/2013-9). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article

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