Evaluating a Phase-Specific Approach to Aortic Flow: A 4D Flow MRI Study

Abstract

Background: Aortic flow parameters can be quantified using 4D flow MRI. However, data are sparse on how different methods of analysis influence these parameters and how these parameters evolve during systole.

Purpose: To assess multiphase segmentations and multiphase quantification of flow-related parameters in aortic 4D flow MRI.

Study type: Prospective.

Population: 40 healthy volunteers (50% male, 28.9 ± 5.0 years) and 10 patients with thoracic aortic aneurysm (80% male, 54 ± 8 years).

Field strength/sequence: 4D flow MRI with a velocity encoded turbo field echo sequence at 3 T.

Assessment: Phase-specific segmentations were obtained for the aortic root and the ascending aorta. The whole aorta was segmented in peak systole. In all aortic segments, time to peak (TTP; for flow velocity, vorticity, helicity, kinetic energy, and viscous energy loss) and peak and time-averaged values (for velocity and vorticity) were calculated.

Statistical tests: Static vs. phase-specific models were assessed using Bland-Altman plots. Other analyses were performed using phase-specific segmentations for aortic root and ascending aorta. TTP for all parameters was compared to TTP of flow rate using paired t-tests. Time-averaged and peak values were assessed using Pearson correlation coefficient. P < 0.05 was considered statistically significant.

Results: In the combined group, velocity in static vs. phase-specific segmentations differed by 0.8 cm/sec for the aortic root, and 0.1 cm/sec (P = 0.214) for the ascending aorta. Vorticity differed by 167 sec^-1 mL^-1 (P = 0.468) for the aortic root, and by 59 sec^-1 mL^-1 (P = 0.481) for the ascending aorta. Vorticity, helicity, and energy loss in the ascending aorta, aortic arch, and descending aorta peaked significantly later than flow rate. Time-averaged velocity and vorticity values correlated significantly in all segments.

Data conclusion: Static 4D flow MRI segmentation yields comparable results as multiphase segmentation for flow-related parameters, eliminating the need for time-consuming multiple segmentations. However, multiphase quantification is necessary for assessing peak values of aortic flow-related parameters.

Level of evidence: 2 TECHNICAL EFFICACY STAGE: 3.

Keywords: 4D flow MRI; MRI; aorta; blood flow.