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Time-Resolved 3-Dimensional Magnetic Resonance Velocity Mapping at 3 T Reveals Drastic Changes in Flow Patterns in a Partially Thrombosed Aortic Arch

2006; Lippincott Williams & Wilkins; Volume: 113; Issue: 11 Linguagem: Inglês

10.1161/circulationaha.105.574103

1524-4539

Alex Frydrychowicz, Ernst Weigang, Andreas Harloff, Friedhelm Beyersdorf, Jürgen Hennig, Mathias Langer, Michael Markl,

Aortic aneurysm repair treatments

HomeCirculationVol. 113, No. 11Time-Resolved 3-Dimensional Magnetic Resonance Velocity Mapping at 3 T Reveals Drastic Changes in Flow Patterns in a Partially Thrombosed Aortic Arch Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBTime-Resolved 3-Dimensional Magnetic Resonance Velocity Mapping at 3 T Reveals Drastic Changes in Flow Patterns in a Partially Thrombosed Aortic Arch Alex Frydrychowicz, MD, Ernst Weigang, MD, Andreas Harloff, MD, Friedhelm Beyersdorf, MD, Jürgen Hennig, PhD, Mathias Langer, MD, MBA and Michael Markl, PhD Alex FrydrychowiczAlex Frydrychowicz From the Departments of Diagnostic Radiology (A.F., M.L.), Medical Physics (J.H., M.M.), Cardiovascular Surgery (E.W., F.B.), and Neurophysiology (A.H.), University Hospital, Albert-Ludwigs-University, Freiburg, Germany. Search for more papers by this author , Ernst WeigangErnst Weigang From the Departments of Diagnostic Radiology (A.F., M.L.), Medical Physics (J.H., M.M.), Cardiovascular Surgery (E.W., F.B.), and Neurophysiology (A.H.), University Hospital, Albert-Ludwigs-University, Freiburg, Germany. Search for more papers by this author , Andreas HarloffAndreas Harloff From the Departments of Diagnostic Radiology (A.F., M.L.), Medical Physics (J.H., M.M.), Cardiovascular Surgery (E.W., F.B.), and Neurophysiology (A.H.), University Hospital, Albert-Ludwigs-University, Freiburg, Germany. Search for more papers by this author , Friedhelm BeyersdorfFriedhelm Beyersdorf From the Departments of Diagnostic Radiology (A.F., M.L.), Medical Physics (J.H., M.M.), Cardiovascular Surgery (E.W., F.B.), and Neurophysiology (A.H.), University Hospital, Albert-Ludwigs-University, Freiburg, Germany. Search for more papers by this author , Jürgen HennigJürgen Hennig From the Departments of Diagnostic Radiology (A.F., M.L.), Medical Physics (J.H., M.M.), Cardiovascular Surgery (E.W., F.B.), and Neurophysiology (A.H.), University Hospital, Albert-Ludwigs-University, Freiburg, Germany. Search for more papers by this author , Mathias LangerMathias Langer From the Departments of Diagnostic Radiology (A.F., M.L.), Medical Physics (J.H., M.M.), Cardiovascular Surgery (E.W., F.B.), and Neurophysiology (A.H.), University Hospital, Albert-Ludwigs-University, Freiburg, Germany. Search for more papers by this author and Michael MarklMichael Markl From the Departments of Diagnostic Radiology (A.F., M.L.), Medical Physics (J.H., M.M.), Cardiovascular Surgery (E.W., F.B.), and Neurophysiology (A.H.), University Hospital, Albert-Ludwigs-University, Freiburg, Germany. Search for more papers by this author Originally published21 Mar 2006https://doi.org/10.1161/CIRCULATIONAHA.105.574103Circulation. 2006;113:e460–e461A 36-year-old female patient presented with recurrent arterial emboli of both arms and a suspected transient ischemic attack. Routine thoracic contrast-enhanced, 3D magnetic resonance angiography (CE-MRA) at 3 T was performed to rule out additional arterial thrombi. The resulting CE-MRA images and consecutive, curved, multiplanar reconstructions (Figure 1B and 1C) revealed a partially obstructing thrombus (as a signal void in the otherwise-bright aortic lumen) in the aortic arch and the proximal left subclavian artery. In contrast, maximum-intensity-projection analysis (Figure 1A) did not depict these findings, which mimicked normal aortic geometry. Download figureDownload PowerPointFigure 1. A, Inconspicuous CE maximum-intensity projection of MRA at 3-T field strength. No obvious cause for the concomitant multiple peripheral arterial occlusions in this young woman were seen. B, CE gradient-echo images and consecutive, curved, multiplanar reconstructions show a y-shaped thrombus in the aortic arch that (C) partially obstructs the vessel lumen, as depicted in the orthogonal reconstruction (level marked by the dashed line).To analyze the hemodynamic consequences of the local geometric changes in the aortic lumen, time-resolved 3D MR velocity mapping was performed. ECG-gated and navigator-controlled data acquisition during free breathing allowed complete spatial and temporal coverage of blood flow in 3D. Various visualization modes of filtered and noise-reduced data included vector graphs and particle traces as well as streamlines. Figure 2 shows the 3D particle-trace visualization of the intricate impact of the thrombus on blood flow in the proximal descending aorta. Particle traces were initiated at a set of emitter points located orthogonal to the aortic arch in the region of the thrombus (yellow dashed line, Figure 1B). The individual images show the temporal evolution of blood flow characteristics at 3 distinct systolic time frames within the cardiac cycle. Next to an initially detected and physiologically expected acceleration of flow through the luminal narrowing (white arrows), considerable complex and vortical flow patterns were observed in the proximal descending aorta (open arrow). These substantial hemodynamic changes may lead to increased strain of the aortic wall and result in secondary morphological alterations. Download figureDownload PowerPointFigure 2. Systolic blood flow in the proximal descending aorta, visualized as 3D particle traces (color coding=absolute local velocity in m/s) in 3 successive time frames. The individual images show the evolution of blood flow characteristics at (A) 168 ms, (B) 257 ms, and (C) 358 ms within the cardiac cycle (tECG). White arrows point to the physiologically expected flow acceleration; the open arrows mark the complex vortical flow pattern that was not expected in normal aortic geometries. (See also the online-only Data Supplement.)Flow experiments were performed with a 3 T MR system (Magnetom TRIO, Siemens, Erlangen, Germany) with a radiofrequency spoiled gradient echo sequence with interleaved 3-directional velocity encoding. Measurements were performed during free breathing and prospectively gated to the ECG cycle. Respiration control was achieved with navigator gating and combined with adaptive k-space reordering to improve scan efficiency. Data were acquired with α=15°, velocity sensitivity=150 cm/s, spatial resolution of 3.2×2.1×5.0 mm3, echo time=3.5 ms, repetition time=5.6 ms, and temporal resolution=45 ms. Blood flow visualization was performed with use of a commercially available software package (EnSight, CEI, Apex, NC).The online-only Data Supplement, which contains a movie, can be found at http://circ.ahajournals.org/cgi/content/full/113/11/e460/DC1.DisclosuresDr Markl is supported by research grant MA 2383/3-1 by Deutsche Forshungsgemeinschaft. The other authors report no conflicts.FootnotesCorrespondence to Dr A. Frydrychowicz, Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Annio G, Torii R, Ducci A, Muthurangu V, Tsang V and Burriesci G (2021) Experimental Validation of Enhanced Magnetic Resonance Imaging (EMRI) Using Particle Image Velocimetry (PIV), Annals of Biomedical Engineering, 10.1007/s10439-021-02811-1, 49:12, (3481-3493), Online publication date: 1-Dec-2021. Yoneyama K, Kitanaka Y, Tanaka O and Akashi Y (2018) Cardiovascular magnetic resonance imaging in heart failure, Expert Review of Cardiovascular Therapy, 10.1080/14779072.2018.1445525, 16:4, (237-248), Online publication date: 3-Apr-2018. Ralovich K, Ionasec R, Mihalef V, Sharma P, Georgescu B, Everett A, Navab N and Comaniciu D (2012) Computational Fluid Dynamics Framework for Large-Scale Simulation in Pediatric Cardiology Computational Biomechanics for Medicine, 10.1007/978-1-4614-3172-5_11, (97-106), . Zhang F and Barker A (2011) Ultrasound and MRI-Based Technique for Quantifying Hemodynamics in Human Cardiovascular Systems Atherosclerosis Disease Management, 10.1007/978-1-4419-7222-4_28, (879-919), . Müller-Eschner M, Rengier F, Partovi S, Unterhinninghofen R, Böckler D, Ley S and von Tengg-Kobligk H (2011) Tridirectional phase-contrast magnetic resonance velocity mapping depicts severe hemodynamic alterations in a patient with aortic dissection type Stanford B, Journal of Vascular Surgery, 10.1016/j.jvs.2011.02.017, 54:2, (559-562), Online publication date: 1-Aug-2011. Johnson K, Wieben O and Samsonov A (2010) Phase-contrast velocimetry with simultaneous fat/water separation, Magnetic Resonance in Medicine, 10.1002/mrm.22355, 63:6, (1564-1574) Liu X, Weale P, Reiter G, Kino A, Dill K, Gleason T, Carroll T and Carr J (2009) Breathhold time-resolved three-directional MR velocity mapping of aortic flow in patients after aortic valve-sparing surgery, Journal of Magnetic Resonance Imaging, 10.1002/jmri.21685, 29:3, (569-575) Morbiducci U, Ponzini R, Rizzo G, Cadioli M, Esposito A, De Cobelli F, Del Maschio A, Montevecchi F and Redaelli A (2008) In Vivo Quantification of Helical Blood Flow in Human Aorta by Time-Resolved Three-Dimensional Cine Phase Contrast Magnetic Resonance Imaging, Annals of Biomedical Engineering, 10.1007/s10439-008-9609-6, 37:3, (516-531), Online publication date: 1-Mar-2009. Canstein C, Cachot P, Faust A, Stalder A, Bock J, Frydrychowicz A, Küffer J, Hennig J and Markl M (2008) 3D MR flow analysis in realistic rapid-prototyping model systems of the thoracic aorta: Comparison with in vivo data and computational fluid dynamics in identical vessel geometries, Magnetic Resonance in Medicine, 10.1002/mrm.21331, 59:3, (535-546), Online publication date: 1-Mar-2008. Weigang E, Kari F, Beyersdorf F, Luehr M, Etz C, Frydrychowicz A, Harloff A and Markl M (2008) Flow-sensitive four-dimensional magnetic resonance imaging: flow patterns in ascending aortic aneurysms, European Journal of Cardio-Thoracic Surgery, 10.1016/j.ejcts.2008.03.047, 34:1, (11-16), Online publication date: 1-Jul-2008. Frydrychowicz A, Berger A, Russe M, Stalder A, Harloff A, Dittrich S, Hennig J, Langer M and Markl M (2008) Time-resolved magnetic resonance angiography and flow-sensitive 4-dimensional magnetic resonance imaging at 3 Tesla for blood flow and wall shear stress analysis, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2008.02.062, 136:2, (400-407), Online publication date: 1-Aug-2008. Harloff A, Strecker C, Frydrychowicz A, Dudler P, Hetzel A, Geibel A, Kollum M, Weiller C, Hennig J and Markl M (2007) Plaques in the descending aorta: A new risk factor for stroke? Visualization of potential embolization pathways by 4D MRI, Journal of Magnetic Resonance Imaging, 10.1002/jmri.21126, 26:6, (1651-1655), Online publication date: 1-Dec-2007. Kari F, Pernice K, Frydrychowicz A, Markl M, Harloff A, Luehr M, Kobba J, Hennig J, Beyersdorf F and Weigang E (2007) Fluss-sensitive 4D MagnetresonanztomographieFlow-sensitive 4D magnetic resonance tomography – blood flow patterns in healthy subjects and in patients with thoracic aortic diseases, Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 10.1007/s00398-007-0566-4, 21:1, (31-38), Online publication date: 1-Feb-2007. Frydrychowicz A, Schlensak C, Stalder A, Russe M, Siepe M, Beyersdorf F, Langer M, Hennig J and Markl M (2007) Ascending–descending aortic bypass surgery in aortic arch coarctation: Four-dimensional magnetic resonance flow analysis, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2006.08.061, 133:1, (260-262.e1), Online publication date: 1-Jan-2007. Vennemann P, Lindken R and Westerweel J (2007) In vivo whole-field blood velocity measurement techniques, Experiments in Fluids, 10.1007/s00348-007-0276-4, 42:4, (495-511), Online publication date: 1-Apr-2007. Unterhinninghofen R, Ley S, Frydrychowicz A and Markl M (2007) MRT-basierte tridirektionale FlussbildgebungMR-based tridirectional flow imaging, Der Radiologe, 10.1007/s00117-007-1577-6, 47:11, (1012-1020), Online publication date: 1-Nov-2007. March 21, 2006Vol 113, Issue 11 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.574103PMID: 16549644 Originally publishedMarch 21, 2006 PDF download Advertisement SubjectsComputerized Tomography (CT)ImagingThrombosis