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      In-vivo validation of interpolation-based phase offset correction in cardiovascular magnetic resonance flow quantification: a multi-vendor, multi-center study

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          Abstract

          Background

          A velocity offset error in phase contrast cardiovascular magnetic resonance (CMR) imaging is a known problem in clinical assessment of flow volumes in vessels around the heart. Earlier studies have shown that this offset error is clinically relevant over different systems, and cannot be removed by protocol optimization. Correction methods using phantom measurements are time consuming, and assume reproducibility of the offsets which is not the case for all systems. An alternative previously published solution is to correct the in-vivo data in post-processing, interpolating the velocity offset from stationary tissue within the field-of-view. This study aims to validate this interpolation-based offset correction in-vivo in a multi-vendor, multi-center setup.

          Methods

          Data from six 1.5 T CMR systems were evaluated, with two systems from each of the three main vendors. At each system aortic and main pulmonary artery 2D flow studies were acquired during routine clinical or research examinations, with an additional phantom measurement using identical acquisition parameters. To verify the phantom acquisition, a region-of-interest (ROI) at stationary tissue in the thorax wall was placed and compared between in-vivo and phantom measurements. Interpolation-based offset correction was performed on the in-vivo data, after manually excluding regions of spatial wraparound. Correction performance of different spatial orders of interpolation planes was evaluated.

          Results

          A total of 126 flow measurements in 82 subjects were included. At the thorax wall the agreement between in-vivo and phantom was − 0.2 ± 0.6 cm/s. Twenty-eight studies were excluded because of a difference at the thorax wall exceeding 0.6 cm/s from the phantom scan, leaving 98. Before correction, the offset at the vessel as assessed in the phantom was − 0.4 ± 1.5 cm/s, which resulted in a − 5 ± 16% error in cardiac output. The optimal order of the interpolation correction plane was 1st order, except for one system at which a 2nd order plane was required. Application of the interpolation-based correction revealed a remaining offset velocity of 0.1 ± 0.5 cm/s and 0 ± 5% error in cardiac output.

          Conclusions

          This study shows that interpolation-based offset correction reduces the offset with comparable efficacy as phantom measurement phase offset correction, without the time penalty imposed by phantom scans.

          Trial registration

          The study was registered in The Netherlands National Trial Register (NTR) under TC 4865. Registered 19 September 2014. Retrospectively registered.

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          Most cited references15

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          Baseline correction of phase contrast images improves quantification of blood flow in the great vessels.

          Phase-contrast Cardiovascular Magnetic Resonance Imaging (CMR) generally requires the analysis of stationary tissue adjacent to a blood vessel to serve as a baseline reference for zero velocity. However, for the heart and great vessels, there is often no stationary tissue immediately adjacent to the vessel. Consequently, uncorrected velocity offsets may introduce substantial errors in flow quantification. The purpose of this study was to assess the magnitude of these flow errors and to validate a clinically applicable method for their correction. In 10 normal volunteers, phase-contrast CMR was used to quantify blood flow in the main pulmonary artery (Qp) and the aorta (Qs). Following image acquisition, phase contrast CMR was performed on a stationary phantom using identical acquisition parameters so as to provide a baseline reference for zero velocity. Aortic and pulmonary blood flow was then corrected using the offset values from the phantom. The mean difference between pulmonary and aortic flow was 26 +/- 21 mL before correction and 7.1 +/- 6.6 mL after correction (p = 0.002). The measured Qp/Qs was 1.25 +/- 0.20 before correction and 1.05 +/- 0.07 after correction (p = 0.001). Phase-contrast CMR can have substantial errors in great vessel flow quantification if there is no correction for velocity offset errors. The proposed method of correction is clinically applicable and provides a more accurate measurement of blood flow.
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            Semiautomated method for noise reduction and background phase error correction in MR phase velocity data.

            Background phase distortion and random noise can adversely affect the quality of magnetic resonance (MR) phase velocity measurements. A semiautomated method has been developed that substantially reduces both effects. To remove the background phase distortion, the following steps were taken: The time standard deviations of the phase velocity images over a cardiac cycle were calculated. Static regions were identified as those in which the standard deviation was low. A flat surface representing an approximation to the background distortion was fitted to the static regions and subtracted from the phase velocity images to give corrected phase images. Random noise was removed by setting to zero those regions in which the standard deviation was high. The technique is demonstrated with a sample set of data in which the in-plane velocities have been measured in an imaging section showing the left ventricular outflow tract of a human left ventricle. The results are presented in vector and contour form, superimposed on the conventional MR angiographic images.
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              Flow measurement by magnetic resonance: a unique asset worth optimising.

              Users and manufacturers of cardiovascular magnetic resonance (CMR) systems have, potentially, an unrivalled asset. Phase contrast mapping of velocities through planes transecting the great arteries should provide the most accurate measurements available of cardiac output, shunt flow, aortic or pulmonary regurgitation and, indirectly, of mitral regurgitation. But the reality is that phase contrast velocity mapping remains under-used, and may have become discredited in the eyes of some CMR users and referring clinicians. Even when appropriate methods of acquisition have been used, there can be inaccuracies of flow measurement on some CMR systems caused by background phase errors due to eddy currents or uncorrected concomitant gradients. Measurements of regurgitant or shunt flow can be seriously affected by these errors which should be minimised or corrected by appropriate hardware and software design. If they have not been, inaccuracies can be detected and corrected by repeating identical velocity acquisitions on a static phantom, and subtracting the corresponding apparent phantom velocities from those of the clinical acquisition. For accurate measurements of aortic regurgitation or mitral inflow, motion tracking and velocity correction with respect to the cyclic displacements of the valves are needed, but few if any commercial systems provide this facility. Measurements of jet velocity pose different challenges, mainly related to the size and placement of voxels relative to a narrow jet. Awareness of the potential problems and concerted efforts towards optimisation are needed from manufacturers and users to make appropriate use of phase contrast flow measurement - a unique strength of cardiovascular magnetic resonance.
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                Author and article information

                Contributors
                mbm.hofman@vumc.nl
                mjarodenburg@gmail.com
                karin.markenroth@med.lu.se
                beat.werner@kispi.uzh.ch
                J.J.M.Westenberg@lumc.nl
                Emanuela.Valsangiacomo@kispi.uzh.ch
                Robin@Nijveldt.net
                o.spruijt@vumc.nl
                phikilner@gmail.com
                ac.vrossum@vumc.nl
                +44 20 73518807 , P.Gatehouse@rbht.nhs.uk
                Journal
                J Cardiovasc Magn Reson
                J Cardiovasc Magn Reson
                Journal of Cardiovascular Magnetic Resonance
                BioMed Central (London )
                1097-6647
                1532-429X
                20 May 2019
                20 May 2019
                2019
                : 21
                : 30
                Affiliations
                [1 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Radiology and Nuclear Medicine, , ICaR-VU, VU University Medical Center, ; PO Box 7057, 1007 MB Amsterdam, the Netherlands
                [2 ]ISNI 0000 0001 0930 2361, GRID grid.4514.4, Lund University Bioimaging Center, , Lund University, ; SE-221 85 Lund, Sweden
                [3 ]Philips Healthcare, SE-164 85 Stockholm, Sweden
                [4 ]ISNI 0000 0001 0726 4330, GRID grid.412341.1, Department Diagnostic Imaging, , University Children’s Hospital, ; Steinwiesstrasse 75, 8032 Zürich, Switzerland
                [5 ]ISNI 0000000089452978, GRID grid.10419.3d, Radiology, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, the Netherlands
                [6 ]ISNI 0000 0001 0726 4330, GRID grid.412341.1, Division of Cardiology, , University Children’s Hospital, ; Steinwiesstrasse 75, 8032 Zürich, Switzerland
                [7 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Cardiology, , ICaR-VU, VU University Medical Center, ; PO Box 7057, 1007 MB Amsterdam, the Netherlands
                [8 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Pulmonology, , ICaR-VU, VU University Medical Center, ; PO Box 7057, 1007 MB Amsterdam, the Netherlands
                [9 ]GRID grid.439338.6, Cardiovascular Magnetic Resonance Unit, , Royal Brompton Hospital, ; Sydney Street, London, SW3 6NP UK
                Author information
                http://orcid.org/0000-0002-0260-4719
                Article
                538
                10.1186/s12968-019-0538-3
                6526620
                31104632
                571d31c3-ed41-4153-9dc9-2b3a310ca709
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 31 May 2018
                : 3 April 2019
                Funding
                Funded by: No funding supported this work.
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Cardiovascular Medicine
                flow quantification,velocity offset,cardiac output,phase contrast velocity mapping,aorta,main pulmonary artery,mri,background offset

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