Evaluation of elevated mean pulmonary arterial pressure based on magnetic resonance 4D velocity mapping: comparison of visualization techniques

Ursula Reiter; Gert Reiter; Gabor Kovacs; Aurelien F Stalder; Mehmet A Gulsun; Andreas Greiser; Horst Olschewski; Michael Fuchsjäger

doi:10.1371/journal.pone.0082212

Evaluation of elevated mean pulmonary arterial pressure based on magnetic resonance 4D velocity mapping: comparison of visualization techniques

PLoS One. 2013 Dec 12;8(12):e82212. doi: 10.1371/journal.pone.0082212. eCollection 2013.

Authors

Ursula Reiter¹, Gert Reiter², Gabor Kovacs³, Aurelien F Stalder⁴, Mehmet A Gulsun⁵, Andreas Greiser⁴, Horst Olschewski³, Michael Fuchsjäger¹

Affiliations

¹ Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
² Siemens AG, Healthcare Sector, Graz, Austria.
³ Division of Pulmology, Department of Internal Medicine, Medical University of Graz & LBI for Lung Vascular Research, Graz, Austria.
⁴ Siemens AG, Healthcare Sector, Erlangen, Germany.
⁵ Siemens Corporate Research, Baltimore, United States.

Abstract

Purpose: Three-dimensional (3D) magnetic resonance phase contrast imaging (PC-MRI) allows non-invasive diagnosis of pulmonary hypertension (PH) and estimation of elevated mean pulmonary arterial pressure (mPAP) based on vortical motion of blood in the main pulmonary artery. The purpose of the present study was to compare the presence and duration of PH-associated vortices derived from different flow visualization techniques with special respect to their performance for non-invasive assessment of elevated mPAP and diagnosis of PH.

Methods: Fifty patients with suspected PH (23 patients with and 27 without PH) were investigated by right heart catheterization and time-resolved PC-MRI of the main pulmonary artery. PC-MRI data were visualized with dedicated prototype software, providing 3D vector, multi-planar reformatted (MPR) 2D vector, streamline, and particle trace representation of flow patterns. Persistence of PH-associated vortical blood flow (tvortex) was evaluated with all visualization techniques. Dependencies of tvortex on visualization techniques were analyzed by means of correlation and receiver operating characteristic (ROC) curve analysis.

Results: tvortex values from 3D vector visualization correlated strongly with those from other visualization techniques (r = 0.98, 0.98 and 0.97 for MPR, streamline and particle trace visualization, respectively). Areas under ROC curves for diagnosis of PH based on tvortex did not differ significantly and were 0.998 for 3D vector, MPR vector and particle trace visualization and 0.999 for streamline visualization. Correlations between elevated mPAP and tvortex in patients with PH were r = 0.96, 0.93, 0.95 and 0.92 for 3D vector, MPR vector, streamline and particle trace visualization, respectively. Corresponding standard deviations from the linear regression lines ranged between 3 and 4 mmHg.

Conclusion: 3D vector, MPR vector, streamline as well as particle trace visualization of time-resolved 3D PC-MRI data of the main pulmonary artery can be employed for accurate vortex-based diagnosis of PH and estimation of elevated mPAP.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Arterial Pressure / physiology*
Demography
Female
Humans
Hypertension, Pulmonary / diagnosis
Hypertension, Pulmonary / physiopathology*
Linear Models
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Observer Variation
Pulmonary Artery / physiopathology*
ROC Curve
Regional Blood Flow
Systole
Young Adult

Grants and funding

The project was supported by a grant of the Styrian government (grant number ABT08–16.R-8/2013-9). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.