Semi-automatic quantification of 4D left ventricular blood flow
Jonatan Eriksson1, Carl Johan Carlhäll, Petter Dyverfeldt
1Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. jonatan.eriksson@liu.se
Insights
A new semi-automatic method accurately quantifies four-dimensional (4D) blood flow in the left ventricle (LV) using cardiovascular magnetic resonance (CMR). This approach offers high reproducibility for assessing intra-cardiac blood flow components.
Area of Science:
- Cardiovascular imaging
- Biomedical engineering
- Fluid dynamics
Background:
- Intra-cardiac blood flow is crucial for cardiovascular health.
- Disease can disrupt normal blood flow patterns within the heart.
- Accurate quantification methods for 4D intra-cardiac blood flow are currently limited.
Purpose of the Study:
- To develop and validate a novel semi-automatic analysis approach for quantifying 4D intra-cardiac blood flow.
- To integrate cardiovascular magnetic resonance (CMR) flow and morphological data.
- To address the lack of precise methods for intra-cardiac blood flow quantification.
Main Methods:
- Acquired 3D cine phase-contrast CMR velocity data and balanced steady-state free-precession images in healthy subjects and patients with dilated cardiomyopathy.
- Segmented the left ventricle (LV) endocardium and traced pathlines through the cardiac cycle.
- Developed an automated method to separate pathlines into four flow components: Direct Flow, Retained Inflow, Delayed Ejection Flow, and Residual Volume.
Main Results:
- Successfully determined the volume and distribution of LV flow components in all subjects.
- Calculated LV outflow volumes were consistent with existing methods, falling between through-plane phase-contrast CMR and Doppler ultrasound values.
- Demonstrated low inter- and intra-observer variability for assessing the volumes of LV inflow, outflow, and the four distinct flow components.
Conclusions:
- The developed semi-automatic analysis approach enables accurate quantification of 4D blood flow.
- The method provides accurate left ventricular (LV) inflow and outflow volumes.
- Achieved high reproducibility in assessing LV flow components, offering a valuable tool for cardiovascular research and clinical practice.
Background:
The beating heart is the generator of blood flow through the cardiovascular system. Within the heart's 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.
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