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Hemodynamic aspects of mitral regurgitation assessed by generalized phase-contrast MRI
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Faculty of Health Sciences. Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology. Linköping University, Department of Medical and Health Sciences, Physiology.
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.ORCID iD: 0000-0003-2198-9690
Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
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2011 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 33, no 3, 582-588 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: Mitral regurgitation creates a high velocity jet into the left atrium (LA), contributing both volume andpressure; we hypothesized that the severity of regurgitation would be reflected in the degree of LA flowdistortion.

Material and Methods: Three-dimensional cine PC-MRI was applied to determine LA flow patterns andturbulent kinetic energy (TKE) in seven subjects (five patients with posterior mitral leaflet prolapse, two normalsubjects). In addition, the regurgitant volume and the time-velocity profiles in the pulmonary veins weremeasured.

Results: The LA flow in the mitral regurgitation patients was highly disturbed with elevated values of TKE.Peak TKE occurred consistently at late systole. The total LA TKE was closely related to the regurgitant volume.LA flow patterns were characterized by a pronounced vortex in proximity to the regurgitant jet. In some patients,pronounced discordances were observed between individual pulmonary venous inflows, but these could not berelated to the direction of the flow jet or parameters describing global LA hemodynamics.

Conclusion: PC-MRI permits investigations of atrial and pulmonary vein flow patterns and TKE in significantmitral regurgitation, reflecting the impact of the highly disturbed blood flow that accompanies this importantvalve disease.

Place, publisher, year, edition, pages
John Wiley and Sons , 2011. Vol. 33, no 3, 582-588 p.
Keyword [en]
Hemodynamics, mitral valve insufficiency, turbulent flow, phase-contrast magnetic resonance imaging, pulmonary veins, blood flow velocity
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-53190DOI: 10.1002/jmri.22407ISI: 000287951100009OAI: diva2:287580
Available from: 2010-01-19 Created: 2010-01-19 Last updated: 2013-12-17
In thesis
1. Extending MRI to the Quantification of Turbulence Intensity
Open this publication in new window or tab >>Extending MRI to the Quantification of Turbulence Intensity
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In cardiovascular medicine, the assessment of blood flow is fundamental to the understanding and detection of disease. Many pharmaceutical, interventional, and surgical treatments impact the flow. The primary purpose of the cardiovascular system is to drive, control and maintain blood flow to all parts of the body. In the normal cardiovascular system, fluid transport is maintained at high efficiency and the blood flow is essentially laminar. Disturbed and turbulent blood flow, on the other hand, appears to be present in many cardiovascular diseases and may contribute to their initiation and progression. Despite strong indications of an important interrelationship between flow and cardiovascular disease, medical imaging has lacked a non-invasive tool for the in vivo assessment of disturbed and turbulent flow. As a result, the extent and role of turbulence in the blood flow of humans have not yet been fully investigated.

Magnetic resonance imaging (MRI) is a versatile tool for the non-invasive assessment of flow and has several important clinical and research applications, but might not yet have reached its full potential. Conventional MRI techniques for the assessment of flow are based on measurements of the mean velocity within an image voxel. The mean velocity corresponds to the first raw moment of the distribution of velocities within a voxel. An MRI framework for the quantification of any moment (mean, standard deviation, skew, etc.) of arbitrary velocity distributions is presented in this thesis.

Disturbed and turbulent flows are characterized by velocity fluctuations that are superimposed on the mean velocity. The intensity of these velocity fluctuations can be quantified by their standard deviation, which is a commonly used measure of turbulence intensity. This thesis focuses on the development of a novel MRI method for the quantification of turbulence intensity. This method is mathematically derived and experimentally validated. Limitations and sources of error are investigated and guidelines for adequate application of MRI measurements of turbulence intensity are outlined. Furthermore, the method is adapted to the quantification of turbulence intensity in the pulsatile blood flow of humans and applied to a wide range of cardiovascular diseases. In these applications, elevated turbulence intensity was consistently detected in regions where highly disturbed flow was anticipated, and the effects of potential sources of errors were small.

Diseased heart valves are often replaced with prosthetic heart valves, which, in spite of improved benefits and durability, continue to fall short of matching native flow patterns. In an in vitro setting, MRI was used to visualize and quantify turbulence intensity in the flow downstream from four common designs of prosthetic heart valves. Marked differences in the extent and degree of turbulence intensity were detected between the different valves.

Mitral valve regurgitation is a common valve lesion associated with progressive left atrial and left ventricular remodelling, which may often require surgical correction to avoid irreversible ventricular dysfunction. The spatiotemporal dynamics of flow disturbances in mitral regurgitation were assessed based on measurements of flow patterns and turbulence intensity in a group of patients with significant regurgitation arising from similar valve lesions. Peak turbulence intensity occurred at the same time in all patients and the total turbulence intensity in the left atrium appeared closely related to the severity of regurgitation.

MRI quantification of turbulence intensity has the potential to become a valuable tool in investigating the extent, timing and role of disturbed blood flow in the human cardiovascular system, as well as in the assessment of the effects of different therapeutic options in patients with vascular or valvular disorders.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 73 p.
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1297
Turbulence intensity, cardiovascular disease, blood flow, hemodynamics, magnetic resonance imaging, generalized phase-contrast MRI, turbulent flow
National Category
Biomedical Laboratory Science/Technology Fluid Mechanics and Acoustics
urn:nbn:se:liu:diva-52561 (URN)978-91-7393-453-4 (ISBN)
Public defence
2010-02-12, Elsa-Brändströmsalen, Universitetssjukhuset, Campus US. Linköpings universitet, Linköping, 09:15 (English)
Available from: 2010-01-19 Created: 2010-01-04 Last updated: 2013-09-03Bibliographically approved

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Dyverfeldt, PetterEscobar Kvitting, John-PederCarlhäll, Carl JohanBoano, GabriellaSigfridsson, AndreasHermansson, UlfBolger, Ann F.Engvall, JanEbbers, Tino
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Center for Medical Image Science and Visualization, CMIVFaculty of Health SciencesApplied Thermodynamics and Fluid MechanicsThe Institute of TechnologyPhysiologyDepartment of Thoracic and Vascular SurgeryClinical PhysiologyDepartment of Clinical PhysiologyDepartment of CardiologyThoracic Surgery
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