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Updated: Jan 2, 2026
In vitro Assessment of Aortic Regurgitation Using Four-Dimensional Flow Magnetic Resonance Imaging
Published on: February 25, 2022
Comparison of different methods for the estimation of aortic pulse wave velocity from 4D flow cardiovascular magnetic
Sophia Houriez-Gombaud-Saintonge1,2,3, Elie Mousseaux4, Ioannis Bargiotas5
1Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), 75006, Paris, France.
Insights
Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) can accurately estimate aortic stiffness. This method shows strong associations with established measures and is reproducible, offering a valuable tool for assessing cardiovascular health.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Medical Physics
Background:
- Arterial pulse wave velocity (PWV) is a key indicator of cardiovascular aging and disease, linked to increased mortality.
- Carotid-femoral PWV (Cf-PWV) and 2D cardiovascular magnetic resonance (CMR) are established methods for assessing aortic stiffness.
- 4D flow CMR offers a comprehensive approach to evaluating aortic stiffness through various estimation methods.
Purpose of the Study:
- To compare different aortic PWV (aoPWV) estimation methods using 4D flow CMR.
- To assess the association of 4D flow CMR aoPWV with age, Cf-PWV, Bramwell-Hill PWV (BH-PWV), and left ventricular (LV) mass-to-volume ratio.
- To evaluate the inter-observer reproducibility and robustness to temporal resolution of 4D flow CMR aoPWV methods.
Main Methods:
- 47 healthy subjects underwent Cf-PWV and CMR, including 4D flow and 2D cine SSFP.
- Aortic segmentation and mean velocity waveforms were derived from 4D flow data.
- aoPWV was calculated using 2D-like (S1) and 3D-like (S2, S3) strategies with different transit time (TT) calculations (cross-correlation, wavelets, Fourier transforms).
Main Results:
- 4D flow CMR aoPWV estimates significantly correlated with Cf-PWV, BH-PWV, age, and LV mass-to-volume ratio (all p < 0.05).
- The 3D-like strategy using wavelets TT (S2-TTw) showed the strongest correlations (e.g., R=0.77 for age).
- S2-TTw demonstrated high inter-observer reproducibility (ICC=0.99) and robustness to lower temporal resolution (ICC=0.97).
Conclusions:
- Reproducible aoPWV measurements can be obtained from 4D flow CMR using full 3D aortic coverage.
- 4D flow CMR-derived stiffness measures are significantly associated with established clinical parameters.
- The 3D strategy with wavelets transit time (S2-TTw) shows particular promise for clinical application.
Background:
Arterial pulse wave velocity (PWV) is associated with increased mortality in aging and disease. Several studies have shown the accuracy of applanation tonometry carotid-femoral PWV (Cf-PWV) and the relevance of evaluating central aorta stiffness using 2D cardiovascular magnetic resonance (CMR) to estimate PWV, and aortic distensibility-derived PWV through the theoretical Bramwell-Hill model (BH-PWV). Our aim was to compare various methods of aortic PWV (aoPWV) estimation from 4D flow CMR, in terms of associations with age, Cf-PWV, BH-PWV and left ventricular (LV) mass-to-volume ratio while evaluating inter-observer reproducibility and robustness to temporal resolution.
Methods:
We studied 47 healthy subjects (49.5 ± 18 years) who underwent Cf-PWV and CMR including aortic 4D flow CMR as well as 2D cine SSFP for BH-PWV and LV mass-to-volume ratio estimation. The aorta was semi-automatically segmented from 4D flow data, and mean velocity waveforms were estimated in 25 planes perpendicular to the aortic centerline. 4D flow CMR aoPWV was calculated: using velocity curves at two locations, namely ascending aorta (AAo) and distal descending aorta (DAo) aorta (S1, 2D-like strategy), or using all velocity curves along the entire aortic centreline (3D-like strategies) with iterative transit time (TT) estimates (S2) or a plane fitting of velocity curves systolic upslope (S3). For S1 and S2, TT was calculated using three approaches: cross-correlation (TTc), wavelets (TTw) and Fourier transforms (TTf). Intra-class correlation coefficients (ICC) and Bland-Altman biases (BA) were used to evaluate inter-observer reproducibility and effect of lower temporal resolution.
Results:
4D flow CMR aoPWV estimates were significantly (p < 0.05) correlated to the CMR-independent Cf-PWV, BH-PWV, age and LV mass-to-volume ratio, with the strongest correlations for the 3D-like strategy using wavelets TT (S2-TTw) (R = 0.62, 0.65, 0.77 and 0.52, respectively, all p < 0.001). S2-TTw was also highly reproducible (ICC = 0.99, BA = 0.09 m/s) and robust to lower temporal resolution (ICC = 0.97, BA = 0.15 m/s).
Conclusions:
Reproducible 4D flow CMR aoPWV estimates can be obtained using full 3D aortic coverage. Such 4D flow CMR stiffness measures were significantly associated with Cf-PWV, BH-PWV, age and LV mass-to-volume ratio, with a slight superiority of the 3D strategy using wavelets transit time (S2-TTw).
