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Semi-automatic quantification of 4D left ventricular blood flow
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
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
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.
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.
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2010 (English)In: JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE, ISSN 1097-6647, Vol. 12, no 9Article in journal (Refereed) Published
Abstract [en]

Background: The beating heart is the generator of blood flow through the cardiovascular system. Within the hearts own chambers, normal complex blood flow patterns can be disturbed by diseases. Methods for the quantification of intra-cardiac blood flow, with its 4D (3D+time) nature, are lacking. We sought to develop and validate a novel semi-automatic analysis approach that integrates flow and morphological data. Method: In six healthy subjects and three patients with dilated cardiomyopathy, three-directional, three-dimensional cine phase-contrast cardiovascular magnetic resonance (CMR) velocity data and balanced steady-state free-precession long- and short-axis images were acquired. The LV endocardium was segmented from the short-axis images at the times of isovolumetric contraction (IVC) and isovolumetric relaxation (IVR). At the time of IVC, pathlines were emitted from the IVC LV blood volume and traced forwards and backwards in time until IVR, thus including the entire cardiac cycle. The IVR volume was used to determine if and where the pathlines left the LV. This information was used to automatically separate the pathlines into four different components of flow: Direct Flow, Retained Inflow, Delayed Ejection Flow and Residual Volume. Blood volumes were calculated for every component by multiplying the number of pathlines with the blood volume represented by each pathline. The accuracy and inter- and intra-observer reproducibility of the approach were evaluated by analyzing volumes of LV inflow and outflow, the four flow components, and the end-diastolic volume. Results: The volume and distribution of the LV flow components were determined in all subjects. The calculated LV outflow volumes [ml] (67 +/- 13) appeared to fall in between those obtained by through-plane phase-contrast CMR (77 +/- 16) and Doppler ultrasound (58 +/- 10), respectively. Calculated volumes of LV inflow (68 +/- 11) and outflow (67 +/- 13) were well matched (NS). Low inter- and intra-observer variability for the assessment of the volumes of the flow components was obtained. Conclusions: This semi-automatic analysis approach for the quantification of 4D blood flow resulted in accurate LV inflow and outflow volumes and a high reproducibility for the assessment of LV flow components.

Place, publisher, year, edition, pages
2010. Vol. 12, no 9
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-54610DOI: 10.1186/1532-429X-12-9ISI: 000275445000001OAI: diva2:305992

The original article is: Jonatan Eriksson, Carljohan Carlhäll, Petter Dyverfeldt, Jan Engvall, Ann F Bolger and Tino Ebbers, Semi-automatic quantification of 4D left ventricular blood flow, 2010, JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE, (12), 9.

Available from: 2010-03-26 Created: 2010-03-26 Last updated: 2014-01-15Bibliographically approved
In thesis
1. Quantification of 4D Left Ventricular Blood Flow in Health and Disease
Open this publication in new window or tab >>Quantification of 4D Left Ventricular Blood Flow in Health and Disease
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main function of the heart is to pump blood throughout the cardiovascular system by generating pressure differences created through volume changes. Although the main purpose of the heart and vessels is to lead the flowing blood throughout the body, clinical assessments of cardiac function are usually based on morphology, approximating the flow features by viewing the motion of the myocardium and vessels. Measurement of three-directional, three-dimensional and time-resolved velocity (4D Flow) data is feasible using magnetic resonance (MR). The focus of this thesis is the development and application of methods that facilitate the analysis of larger groups of data in order to increase our understanding of intracardiac flow patterns and take the 4D flow technique closer to the clinical setting.

In the first studies underlying this thesis, a pathline based method for analysis of intra ventricular blood flow patterns has been implemented and applied. A pathline is integrated from the velocity data and shows the path an imaginary massless particle would take through the data volume. This method separates the end-diastolic volume (EDV) into four functional components, based on the position for each individual pathline at end-diastole (ED) and end-systole (ES). This approach enables tracking of the full EDV over one cardiac cycle and facilitates calculation of parameters such as e.g. volumes and kinetic energy (KE). Besides blood flow, pressure plays an important role in the cardiac dynamics. In order to study this parameter in the left ventricle, the relative pressure field was computed using the pressure Poisson equation. A comprehensive presentation of the pressure data was obtained dividing the LV blood pool into 17 pie-shaped segments based on a modification of the standard seventeen segment model. Further insight into intracardiac blood flow dynamics was obtained by studying the turbulent kinetic energy (TKE) in the LV. The methods were applied to data from a group of healthy subjects and patients with dilated cardiomyopathy (DCM). DCM is a pathological state where the cardiac function is impaired and the left ventricle or both ventricles are dilated.

The validation study of the flow analysis method showed that a reliable user friendly tool for intra ventricular blood flow analysis was obtained. The application of this tool also showed that roughly one third of the blood that enters the LV, directly leaves the LV again in the same heart beat. The distribution of the four LV EDV components was altered in the DCM group as compared to the healthy group; the component that enters and leaves the LV during one cardiac cycle (Direct Flow) was significantly larger in the healthy subjects. Furthermore, when the kinetic energy was normalized by the volume for each component, at time of ED, the Direct Flow had the highest values in the healthy subjects. In the DCM group, however, the Retained Inflow and Delayed Ejection Flow had higher values. The relative pressure field showed to be highly heterogeneous, in the healthy heart. During diastole the predominate pressure differences in the LV occur along the long axis from base to apex. The distribution and variability of 3D pressure fields differ between early and late diastolic filling phases, but common to both phases is a relatively lower pressure in the outflow segment. In the normal LV, TKE values are low. The highest TKE values can be seen during early diastole and are regionally distributed near the basal LV regions. In contrast, in a heterogeneous group of DCM patients, total diastolic and late diastolic TKE values are higher than in normals, and increase with the LV volume.

In conclusion, in this thesis, methods for analysis of multidirectional intra cardiac velocity data have been obtained. These methods allow assessment of data quality, intra cardiac blood flow patterns, relative pressure fields, and TKE. Using these methods, new insights have been obtained in intra cardiac blood flow dynamics in health and disease. The work underlying this thesis facilitates assessment of data from a larger population of healthy subjects and patients, thus bringing the 4D Flow MRI technique closer to the clinical setting.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 63 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1374
MRI, relative pressure, 4D flow, quantification, turbulent kinetic energy, dilated cardiomyopathy, magnetic resonance imaging, physiology, cardiac function, diastolic dysfunction
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-98786 (URN)10.3384/diss.diva-99958 (DOI)978-91-7519-542-1 (print) (ISBN)
Public defence
2013-11-22, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Available from: 2013-10-14 Created: 2013-10-14 Last updated: 2014-04-23Bibliographically approved

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Eriksson, JonatanCarlhäll, CarljohanDyverfeldt, PetterEngvall, JanBolger, Ann FEbbers, Tino
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