liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Carlhäll, CarljohanORCID iD iconorcid.org/0000-0003-2198-9690
Alternative names
Publications (10 of 51) Show all publications
Lantz, J., Gupta, V., Henriksson, L., Karlsson, M., Persson, A., Carlhäll, C.-J. & Ebbers, T. (2019). Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations: Comparison with In Vivo 4D Flow MRI. Annals of Biomedical Engineering, 47(2), 413-424
Open this publication in new window or tab >>Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations: Comparison with In Vivo 4D Flow MRI
Show others...
2019 (English)In: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 47, no 2, p. 413-424Article in journal (Refereed) Published
Abstract [en]

Blood flow simulations are making their way into the clinic, and much attention is given to estimation of fractional flow reserve in coronary arteries. Intracardiac blood flow simulations also show promising results, and here the flow field is expected to depend on the pulmonary venous (PV) flow rates. In the absence of in vivo measurements, the distribution of the flow from the individual PVs is often unknown and typically assumed. Here, we performed intracardiac blood flow simulations based on time-resolved computed tomography on three patients, and investigated the effect of the distribution of PV flow rate on the flow field in the left atrium and ventricle. A design-of-experiment approach was used, where PV flow rates were varied in a systematic manner. In total 20 different simulations were performed per patient, and compared to in vivo 4D flow MRI measurements. Results were quantified by kinetic energy, mitral valve velocity profiles and root-mean-square errors of velocity. While large differences in atrial flow were found for varying PV inflow distributions, the effect on ventricular flow was negligible, due to a regularizing effect by mitral valve. Equal flow rate through all PVs most closely resembled in vivo measurements and is recommended in the absence of a priori knowledge.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2019
Keywords
Sensitivity analysis, Design-of-experiments, Computational fluid dynamics, In vivo measurements
National Category
Medical Image Processing Fluid Mechanics and Acoustics
Identifiers
urn:nbn:se:liu:diva-153252 (URN)10.1007/s10439-018-02153-5 (DOI)000456383600007 ()30362080 (PubMedID)2-s2.0-85055724908 (Scopus ID)
Funder
Knut and Alice Wallenberg Foundation
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2019-03-22Bibliographically approved
Bustamante, M., Gupta, V., Forsberg, D., Carlhäll, C., Engvall, J. & Ebbers, T. (2018). Automated multi-atlas segmentation of cardiac 4D flow MRI. Medical Image Analysis, 49, 128-140
Open this publication in new window or tab >>Automated multi-atlas segmentation of cardiac 4D flow MRI
Show others...
2018 (English)In: Medical Image Analysis, ISSN 1361-8415, E-ISSN 1361-8423, Vol. 49, p. 128-140Article in journal (Refereed) Published
Abstract [en]

Four-dimensional (4D) flow magnetic resonance imaging (4D Flow MRI) enables acquisition of time-resolved three-directional velocity data in the entire heart and all major thoracic vessels. The segmentation of these tissues is typically performed using semi-automatic methods. Some of which primarily rely on the velocity data and result in a segmentation of the vessels only during the systolic phases. Other methods, mostly applied on the heart, rely on separately acquired balanced Steady State Free Precession (b-SSFP) MR images, after which the segmentations are superimposed on the 4D Flow MRI. While b-SSFP images typically cover the whole cardiac cycle and have good contrast, they suffer from a number of problems, such as large slice thickness, limited coverage of the cardiac anatomy, and being prone to displacement errors caused by respiratory motion. To address these limitations we propose a multi-atlas segmentation method, which relies only on 4D Flow MRI data, to automatically generate four-dimensional segmentations that include the entire thoracic cardiovascular system present in these datasets. The approach was evaluated on 4D Flow MR datasets from a cohort of 27 healthy volunteers and 83 patients with mildly impaired systolic left-ventricular function. Comparison of manual and automatic segmentations of the cardiac chambers at end-systolic and end-diastolic timeframes showed agreements comparable to those previously reported for automatic segmentation methods of b-SSFP MR images. Furthermore, automatic segmentation of the entire thoracic cardiovascular system improves visualization of 4D Flow MRI and facilitates computation of hemodynamic parameters.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
4D Flow MRI, Cardiac segmentation, Multi-atlas segmentation, Heart, Magnetic resonance imaging, Automatic segmentations, Directional velocities, Hemodynamic parameters, Left ventricular function, Segmentation methods, Semiautomatic methods, Steady state free precessions, Image segmentation, adult, anatomy, article, cohort analysis, controlled study, error, female, heart cycle, heart left ventricle function, human, human tissue, major clinical study, male, motion, nuclear magnetic resonance imaging, steady state, thickness, volunteer
National Category
Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-150788 (URN)10.1016/j.media.2018.08.003 (DOI)000446286600011 ()30144652 (PubMedID)2-s2.0-85051830661 (Scopus ID)
Note

Funding details: 310612; Funding details: FP7, Seventh Framework Programme; Funding details: 621-2014-6191, VR, Vetenskapsrådet; Funding details: 223615; Funding details: 20140398; Funding text: This work was partially funded by the FP7-funded project DOPPLER-CIP [grant number 223615]; the European Union’s Seventh Framework Programme ( FP7/2007-2013 ) [grant number 310612 ]; the Swedish Research Council [grant number 621-2014-6191 ]; and the Swedish Heart and Lung Foundation [grant number 20140398 ]. 

Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-10-17Bibliographically approved
Lantz, J., Gupta, V., Henriksson, L., Karlsson, M., Persson, A., Carlhäll, C. & Ebbers, T. (2018). Intracardiac Flow at 4D CT: Comparison with 4D Flow MRI. Radiology, 289(1), 51-58
Open this publication in new window or tab >>Intracardiac Flow at 4D CT: Comparison with 4D Flow MRI
Show others...
2018 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 289, no 1, p. 51-58Article in journal (Refereed) Published
Abstract [en]

Purpose

To investigate four-dimensional (4D) flow CT for the assessment of intracardiac blood flow patterns as compared with 4D flow MRI.

Materials and Methods

This prospective study acquired coronary CT angiography and 4D flow MRI data between February and December 2016 in a cohort of 12 participants (age range, 36–74 years; mean age, 57 years; seven men [age range, 36–74 years; mean age, 57 years] and five women [age range, 52–73 years; mean age, 64 years]). Flow simulations based solely on CT-derived cardiac anatomy were assessed together with 4D flow MRI measurements. Flow patterns, flow rates, stroke volume, kinetic energy, and flow components were quantified for both techniques and were compared by using linear regression.

Results

Cardiac flow patterns obtained by using 4D flow CT were qualitatively similar to 4D flow MRI measurements, as graded by three independent observers. The Cohen κ score was used to assess intraobserver variability (0.83, 0.79, and 0.70) and a paired Wilcoxon rank-sum test showed no significant change (P > .05) between gradings. Peak flow rate and stroke volumes between 4D flow MRI measurements and 4D flow CT measurements had high correlation (r = 0.98 and r = 0.81, respectively; P < .05 for both). Integrated kinetic energy quantified at peak systole correlated well (r = 0.95, P < .05), while kinetic energy levels at early and late filling showed no correlation. Flow component analysis showed high correlation for the direct and residual components, respectively (r = 0.93, P < .05 and r = 0.87, P < .05), while the retained and delayed components showed no correlation.

Conclusion

Four-dimensional flow CT produced qualitatively and quantitatively similar intracardiac blood flow patterns compared with the current reference standard, four-dimensional flow MRI.

Place, publisher, year, edition, pages
Oak Brook, IL United States: Radiological Society of North America, Inc., 2018
National Category
Fluid Mechanics and Acoustics Cardiac and Cardiovascular Systems Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-149320 (URN)10.1148/radiol.2018173017 (DOI)000444990900009 ()29944089 (PubMedID)
Funder
Knut and Alice Wallenberg Foundation, Seeing Organ FunctionSwedish Heart Lung Foundation
Available from: 2018-06-28 Created: 2018-06-28 Last updated: 2019-04-12Bibliographically approved
Fredriksson, A. G., Trzebiatowska-Krzynska, A., Dyverfeldt, P., Engvall, J., Ebbers, T. & Carlhäll, C. (2018). Turbulent kinetic energy in the right ventricle: Potential MR marker for risk stratification of adults with repaired Tetralogy of Fallot. Journal of Magnetic Resonance Imaging, 47(4), 1043-1053
Open this publication in new window or tab >>Turbulent kinetic energy in the right ventricle: Potential MR marker for risk stratification of adults with repaired Tetralogy of Fallot
Show others...
2018 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 47, no 4, p. 1043-1053Article in journal (Refereed) Published
Abstract [en]

Purpose: To assess right ventricular (RV) turbulent kinetic energy (TKE) in patients with repaired Tetralogy of Fallot (rToF) and a spectrum of pulmonary regurgitation (PR), as well as to investigate the relationship between these 4D flow markers and RV remodeling.

Materials and Methods: Seventeen patients with rToF and 10 healthy controls were included in the study. Patients were divided into two groups based on PR fraction: one lower PR fraction group (11%) and one higher PR fraction group (>11%). Field strength/sequences: 3D cine phase contrast (4D flow), 2D cine phase contrast (2D flow), and balanced steady-state free precession (bSSFP) at 1.5T. Assessment: The RV volume was segmented in the morphologic short-axis images and TKE parameters were computed inside the segmented RV volume throughout diastole. Statistical tests: One-way analysis of variance with Bonferroni post-hoc test; unpaired t-test; Pearson correlation coefficients; simple and stepwise multiple regression models; intraclass correlation coefficient (ICC).

Results: The higher PR fraction group had more remodeled RVs (140 6 25 vs. 107 6 22 [lower PR fraction, P < 0.01] and 93 6 15 ml/m2[healthy, P < 0.001] for RV end-diastolic volume index [RVEDVI]) and higher TKE values (5.95 6 3.15 vs. 2.23 6 0.81 [lower PR fraction, P < 0.01] and 1.91 6 0.78 mJ [healthy, P < 0.001] for Peak Total RV TKE). Multiple regression analysis between RVEDVI and 4D/2D flow parameters showed that Peak Total RV TKE was the strongest predictor of RVEDVI (R25 0.47, P 5 0.002).

Conclusion: The 4D flow-specific TKE markers showed a slightly stronger association with RV remodeling than conventional 2D flow PR parameters. These results suggest novel hemodynamic aspects of PR in the development of late complications after ToF repair.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
4D flow, MRI, Turbulence, Tetralogy of Fallot, Turbulent kinetic energy
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems Medical Laboratory and Measurements Technologies Anesthesiology and Intensive Care Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-143780 (URN)10.1002/jmri.25830 (DOI)000427125300016 ()28766919 (PubMedID)2-s2.0-85026745981 (Scopus ID)
Note

Funding agencies:  European Research Council [310612]; Swedish Heart and Lung Foundation [20140398]; County Council of Ostergotland; Medical Research Council of Southeast Sweden (FORSS); Swedish Research Council [2013-6077, 2014-6191]

Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2019-01-07Bibliographically approved
Fredriksson, A. G., Svalbring, E., Eriksson, J., Dyverfeldt, P., Alehagen, U., Engvall, J., . . . Carlhäll, C.-J. (2016). 4D flow MRI can detect subtle right ventricular dysfunction in primary left ventricular disease.. Journal of Magnetic Resonance Imaging, 43(3), 558-565
Open this publication in new window or tab >>4D flow MRI can detect subtle right ventricular dysfunction in primary left ventricular disease.
Show others...
2016 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 43, no 3, p. 558-565Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate whether 4D flow magnetic resonance imaging (MRI) can detect subtle right ventricular (RV) dysfunction in primary left ventricular (LV) disease.

MATERIALS AND METHODS: 4D flow and morphological 3T MRI data were acquired in 22 patients with mild ischemic heart disease who were stratified into two groups based on LV end-diastolic volume index (EDVI): lower-LVEDVI and higher-LVEDVI, as well as in 11 healthy controls. The RV volume was segmented at end-diastole (ED) and end-systole (ES). Pathlines were emitted from the ED volume and traced forwards and backwards in time to ES. The blood volume was separated into flow components. The Direct Flow (DF) component was defined as RV inflow passing directly to outflow. The kinetic energy (KE) of the DF component was calculated. Echocardiographic conventional RV indices were also assessed.

RESULTS: The higher-LVEDVI group had larger LVEDVI and lower LV ejection fraction (98 ± 32 ml/m(2) ; 48 ± 13%) compared to the healthy (67 ± 12, P = 0.002; 64 ± 7, P < 0.001) and lower-LVEDI groups (62 ± 10; 68 ± 7, both P < 0.001). The RV 4D flow-specific measures "DF/EDV volume-ratio" and "DF/EDV KE-ratio at ED" were lower in the higher-LVEDVI group (38 ± 5%; 52 ± 6%) compared to the healthy (44 ± 6; 65 ± 7, P = 0.018 and P < 0.001) and lower-LVEDVI groups (44 ± 6; 64 ± 7, P = 0.011 and P < 0.001). There was no difference in any of the conventional MRI and echocardiographic RV indices between the three groups.

CONCLUSION: We found that in primary LV disease mild impairment of RV function can be detected by 4D flow-specific measures, but not by the conventional MRI and echocardiographic indices. J. Magn. Reson. Imaging 2015.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
4D flow MRI; interventricular interaction; left ventricular disease; right ventricular function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124293 (URN)10.1002/jmri.25015 (DOI)000373000300003 ()26213253 (PubMedID)
Note

Funding agencies: Swedish Heart and Lung Foundation; Swedish Research Council; European Union [223615]; Medical Research Council of Southeast Sweden (FORSS); County Council of Ostergotland/Heart and Medicine Center

Available from: 2016-01-25 Created: 2016-01-25 Last updated: 2017-05-03
Folkesson, M., Sadowska, N., Vikingsson, S., Karlsson, M., Carlhäll, C.-J., Länne, T., . . . Jensen, L. (2016). Differences in cardiovascular toxicities associated with cigarette smoking and snuff use revealed using novel zebrafish models. Biology Open, 5(7), 970-978
Open this publication in new window or tab >>Differences in cardiovascular toxicities associated with cigarette smoking and snuff use revealed using novel zebrafish models
Show others...
2016 (English)In: Biology Open, ISSN 2046-6390, Vol. 5, no 7, p. 970-978Article in journal (Refereed) Published
Abstract [en]

Tobacco use is strongly associated with cardiovascular disease and the only avoidable risk factor associated with development of aortic aneurysm. While smoking is the most common form of tobacco use, snuff and other oral tobacco products are gaining popularity, but research on potentially toxic effects of oral tobacco use has not kept pace with the increase in its use. Here, we demonstrate that cigarette smoke and snuff extracts are highly toxic to developing zebrafish embryos. Exposure to such extracts led to a palette of toxic effects including early embryonic mortality, developmental delay, cerebral hemorrhages, defects in lymphatics development and ventricular function, and aneurysm development. Both cigarette smoke and snuff were more toxic than pure nicotine, indicating that other compounds in these products are also associated with toxicity. While some toxicities were found following exposure to both types of tobacco product, other toxicities, including developmental delay and aneurysm development, were specifically observed in the snuff extract group, whereas cerebral hemorrhages were only found in the group exposed to cigarette smoke extract. These findings deepen our understanding of the pathogenic effects of cigarette smoking and snuff use on the cardiovascular system and illustrate the benefits of using zebrafish to study mechanisms involved in aneurysm development.

Place, publisher, year, edition, pages
Company of Biologists, 2016
Keywords
Aneurysm; Aorta; Cardiovascular; Snuff; Tobacco; Zebrafish
National Category
Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:liu:diva-130706 (URN)10.1242/bio.018812 (DOI)000380569100010 ()27334697 (PubMedID)
Note

The Jensen laboratory is supported by grants from Svenska Sallskapet for Medicinsk Forskning [grant F14-0021], Linkopings Universitet, Eva och Oscar Ahrens Stiftelse, Ollie och Elof Ericssons Stiftelse, Carmen och Bertil Ragners Stiftelse, Gosta Fraenkels Stiftelse, Ake Wibergs Stiftelse, Lions Forskningsfond, Karin Sandbergs Stiftelse, Cancerfonden, Karolinska Institutet's Stiftelser och Fonder and Vetenskapsradet [grant 2015-06271].

Available from: 2016-08-21 Created: 2016-08-21 Last updated: 2018-03-19
Andersson, C., Kihlberg, J., Ebbers, T., Lindström, L., Carlhäll, C. & Engvall, J. (2016). Phase-contrast MRI volume flow - a comparison of breath held and navigator based acquisitions. BMC Medical Imaging, 16(26)
Open this publication in new window or tab >>Phase-contrast MRI volume flow - a comparison of breath held and navigator based acquisitions
Show others...
2016 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 16, no 26Article in journal (Refereed) Published
Abstract [en]

Background: Magnetic Resonance Imaging (MRI) 2D phase-contrast flow measurement has been regarded as the gold standard in blood flow measurements and can be performed with free breathing or breath held techniques. We hypothesized that the accuracy of flow measurements obtained with segmented phase-contrast during breath holding, and in particular higher number of k-space segments, would be non-inferior compared to navigator phase-contrast. Volumes obtained from anatomic segmentation of cine MRI and Doppler echocardiography were used for additional reference. Methods: Forty patients, five women and 35 men, mean age 65 years (range 53-80), were randomly selected and consented to the study. All underwent EKG-gated cardiac MRI including breath hold cine, navigator based free-breathing phase-contrast MRI and breath hold phase-contrast MRI using k-space segmentation factors 3 and 5, as well as transthoracic echocardiography within 2 days. Results: In navigator based free-breathing phase-contrast flow, mean stroke volume and cardiac output were 79.7 +/- 17.1 ml and 5071 +/- 1192 ml/min, respectively. The duration of the acquisition was 50 +/- 6 s. With k-space segmentation factor 3, the corresponding values were 77.7 ml +/- 17.5 ml and 4979 +/- 1211 ml/min (p = 0.15 vs navigator). The duration of the breath hold was 17 +/- 2 s. K-space segmentation factor 5 gave mean stroke volume 77.9 +/- 16.4 ml, cardiac output 5142 +/- 1197 ml/min (p = 0.33 vs navigator), and breath hold time 11 +/- 1 s. Anatomical segmentation of cine gave mean stroke volume and cardiac output 91.2 +/- 20.8 ml and 5963 +/- 1452 ml/min, respectively. Echocardiography was reliable in 20 of the 40 patients. The mean diameter of the left ventricular outflow tract was 20.7 +/- 1.5 mm, stroke volume 78.3 ml +/- 15.2 ml and cardiac output 5164 +/- 1249 ml/min. Conclusions: In forty consecutive patients with coronary heart disease, breath holding and segmented k-space sampling techniques for phase-contrast flow produced stroke volumes and cardiac outputs similar to those obtained with free-breathing navigator based phase-contrast MRI, using less time. The values obtained agreed fairly well with Doppler echocardiography while there was a larger difference when compared with anatomical volume determinations using SSFP (steady state free precession) cine MRI.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Phase-contrast flow; Magnetic resonance imaging; Segmentation; 2D Doppler echocardiography
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127432 (URN)10.1186/s12880-016-0128-x (DOI)000372901200001 ()27021353 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Foundation [20120449, 20140398]; Region of Ostergotland [281281]; European Union FP 7 [223615]; Medical Research Council of Southeast Sweden [88731, 157921]

Available from: 2016-05-01 Created: 2016-04-26 Last updated: 2018-03-20Bibliographically approved
Petersson, S., Dyverfeldt, P., Sigfridsson, A., Lantz, J., Carlhäll, C. & Ebbers, T. (2016). Quantification of turbulence and velocity in stenotic flow using spiral three-dimensional phase-contrast MRI. Magnetic Resonance in Medicine, 75(3), 1249-1255
Open this publication in new window or tab >>Quantification of turbulence and velocity in stenotic flow using spiral three-dimensional phase-contrast MRI
Show others...
2016 (English)In: Magnetic Resonance in Medicine, ISSN 0740-3194, E-ISSN 1522-2594, Vol. 75, no 3, p. 1249-1255Article in journal (Refereed) Published
Abstract [en]

PurposeEvaluate spiral three-dimensional (3D) phase contrast MRI for the assessment of turbulence and velocity in stenotic flow. MethodsA-stack-of-spirals 3D phase contrast MRI sequence was evaluated in vitro against a conventional Cartesian sequence. Measurements were made in a flow phantom with a 75% stenosis. Both spiral and Cartesian imaging were performed using different scan orientations and flow rates. Volume flow rate, maximum velocity and turbulent kinetic energy (TKE) were computed for both methods. Moreover, the estimated TKE was compared with computational fluid dynamics (CFD) data. ResultsThere was good agreement between the turbulent kinetic energy from the spiral, Cartesian and CFD data. Flow rate and maximum velocity from the spiral data agreed well with Cartesian data. As expected, the short echo time of the spiral sequence resulted in less prominent displacement artifacts compared with the Cartesian sequence. However, both spiral and Cartesian flow rate estimates were sensitive to displacement when the flow was oblique to the encoding directions. ConclusionSpiral 3D phase contrast MRI appears favorable for the assessment of stenotic flow. The spiral sequence was more than three times faster and less sensitive to displacement artifacts when compared with a conventional Cartesian sequence.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
phase contrast mri; 4d flow; turbulence mapping; spiral; stenosis
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-126831 (URN)10.1002/mrm.25698 (DOI)000370593700030 ()25846511 (PubMedID)
Note

Funding Agencies|European Research Council [310612]; Swedish Research Council; Swedish e-Science Research Centre

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2017-05-03
Petersson, S., Sigfridsson, A., Dyverfeldt, P., Carlhäll, C.-J. & Ebbers, T. (2016). Retrospectively Gated Intra-cardiac 4D Flow MRI using Spiral Trajectories. Magnetic Resonance in Medicine, 75(1), 196-206
Open this publication in new window or tab >>Retrospectively Gated Intra-cardiac 4D Flow MRI using Spiral Trajectories
Show others...
2016 (English)In: Magnetic Resonance in Medicine, ISSN 0740-3194, E-ISSN 1522-2594, Vol. 75, no 1, p. 196-206Article in journal (Refereed) Published
Abstract [en]

Background: Four-dimensional (4D) flow MRI is a powerful tool for the quantification of blood flow and enables calculation of a range of unique hemodynamic parameters. However, the application of cardiac 4D flow MRI is limited by long scan times (20-40 minutes). The high efficiency of spiral readouts can be used to reduce scan times without sacrificing SNR. The aim of this work was to develop and validate a retrospectively gated 4D flow MRI sequence using spiral readouts for the measurement of intra-cardiac velocities.

Methods: A retrospectively ECG gated 4D flow sequence using stacks of spiral readouts was implemented on a clinical 1.5 T MRI scanner. The spiral 4D flow MRI sequence was validated in-vivo by comparisons with a two-dimensional (2D) through-plane velocity measurement and a conventional Cartesian 4D flow acquisition (SENSE factor 2) in 7 healthy volunteers (age 27 ± 3 years, four men) and 2 patients (age 19 and 52, women, only spiral 4D flow and 2D). Net volume flow was estimated from all three acquisition approaches and compared using one-way ANOVA. A quantitative pathline based validation was performed on the Cartesian and the spiral 4D flow MRI acquisitions by comparing the left ventricular inflow and outflow (two-tailed paired t-tests).

Results: The scan time of the spiral 4D flow sequence was 44±6% of the Cartesian counterpart. Compared to time-resolved 2D flow in the aorta, the spiral and Cartesian 4D flow acquisitions provided similarly good data, as there was no significant difference between the net volume flow for all acquisitions (Spiral: 89±14 ml, Cartesian: 93±11 ml, 2D: 93±18 ml, p=0.878). There was no significant difference between pathline-based calculations of inflow and outflow with either Cartesian (In: 88±15, Out: 85±16, p = 0.168) or spiral (In: 93±17 ml, Out: 84±18, p = 0.055) 4D flow acquisitions.

Conclusions: Retrospectively gated spiral cardiac 4D flow MRI permits more than two-fold reduction in scan time compared to conventional Cartesian 4D flow MRI without notable loss in data quality. The time-savings offered by spiral trajectories could provide a step towards the expanded clinical use of 4D flow MRI.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-101103 (URN)10.1002/mrm.25612 (DOI)000367739200019 ()
Note

Funding agencies: European Research Council [310612]; Swedish Research Council; Swedish Heart and Lung foundation

Available from: 2013-11-19 Created: 2013-11-19 Last updated: 2017-05-03Bibliographically approved
Dyverfeldt, P., Bissell, M., Barker, A. J., Bolger, A. F., Carlhäll, C., Ebbers, T., . . . Markl, M. (2015). 4D flow cardiovascular magnetic resonance consensus statement. Journal of Cardiovascular Magnetic Resonance, 17(72)
Open this publication in new window or tab >>4D flow cardiovascular magnetic resonance consensus statement
Show others...
2015 (English)In: Journal of Cardiovascular Magnetic Resonance, ISSN 1097-6647, E-ISSN 1532-429X, Vol. 17, no 72Article, review/survey (Refereed) Published
Abstract [en]

Pulsatile blood flow through the cavities of the heart and great vessels is time-varying and multidirectional. Access to all regions, phases and directions of cardiovascular flows has formerly been limited. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has enabled more comprehensive access to such flows, with typical spatial resolution of 1.5x1.5x1.5 - 3x3x3 mm(3), typical temporal resolution of 30-40 ms, and acquisition times in the order of 5 to 25 min. This consensus paper is the work of physicists, physicians and biomedical engineers, active in the development and implementation of 4D Flow CMR, who have repeatedly met to share experience and ideas. The paper aims to assist understanding of acquisition and analysis methods, and their potential clinical applications with a focus on the heart and greater vessels. We describe that 4D Flow CMR can be clinically advantageous because placement of a single acquisition volume is straightforward and enables flow through any plane across it to be calculated retrospectively and with good accuracy. We also specify research and development goals that have yet to be satisfactorily achieved. Derived flow parameters, generally needing further development or validation for clinical use, include measurements of wall shear stress, pressure difference, turbulent kinetic energy, and intracardiac flow components. The dependence of measurement accuracy on acquisition parameters is considered, as are the uses of different visualization strategies for appropriate representation of time-varying multidirectional flow fields. Finally, we offer suggestions for more consistent, user-friendly implementation of 4D Flow CMR acquisition and data handling with a view to multicenter studies and more widespread adoption of the approach in routine clinical investigations.

Place, publisher, year, edition, pages
BioMed Central / Informa Healthcare, 2015
Keywords
4D Flow CMR; 4D Flow MRI; Phase-contrast magnetic resonance imaging; MR flow imaging; Hemodynamics; Flow visualization; Flow quantification; Recommendations; Clinical; Cardiovascular
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120859 (URN)10.1186/s12968-015-0174-5 (DOI)000359155900001 ()26257141 (PubMedID)
Note

Funding Agencies|Swedish Research Council; Medical Research Council of Southeast Sweden; Linkoping University; British Heart Foundation Centre of Research Excellence; Oxford NIHR Biomedical Research Centre; NIH [K25HL119608]; Swedish Heart and Lung Foundation; European Research Council [HEART4FLOW, 310612]; Radiological Society of North America (RSNA); NIHR Cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust; Imperial College London; National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [R01 R01DK096169]; National Institute of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) [R01HL115828]

Available from: 2015-08-28 Created: 2015-08-28 Last updated: 2017-12-04
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2198-9690

Search in DiVA

Show all publications