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Multimodality comparison of aorta morphology in patients with aortopathy: 4D flow CMR, CTA, mDIXON

Bastiaan J C Te Kiefte1,2, Faeze Gholamiankhah3,4, Joe F Juffermans3,4

  • 1Cardio Vascular Imaging Group (CVIG), Leiden University Medical Center (LUMC), Leiden, The Netherlands. b.j.c.te_kiefte@lumc.nl.

BMC Medical Imaging
|June 3, 2025
PubMed

Insights

Four-dimensional cardiovascular magnetic resonance flow imaging (4D flow CMR) can accurately assess thoracic aorta morphology. This technique shows high agreement with Computed Tomography Angiography (CTA) and mDIXON CMR, potentially enabling single-acquisition analysis of aortic blood flow and structure.

Area of Science:

  • Cardiovascular Imaging
  • Medical Physics
  • Radiology

Background:

  • Four-dimensional cardiovascular magnetic resonance flow imaging (4D flow CMR) analyzes aortic blood flow dynamics.
  • Assessing aortic morphology alongside hemodynamics typically requires additional anatomical imaging.
  • This study investigates the utility of 4D flow CMR for morphological parameter determination.

Purpose of the Study:

  • To compare morphological parameters derived from 4D flow CMR segmentations with those from Computed Tomography Angiography (CTA) and mDIXON CMR.
  • To evaluate the agreement between different imaging modalities in assessing aortic morphology.
  • To determine if 4D flow CMR can serve as a standalone tool for evaluating both aortic morphology and hemodynamics.

Main Methods:

  • 18 patients with diverse aortic pathologies underwent CTA and CMR (including mDIXON and 4D flow CMR).
  • Thoracic aorta lumen was segmented from the aortic valve to the descending aorta into four segments: aortic root, ascending aorta, aortic arch, and descending aorta.
  • Morphological parameters (maximum diameter, volume, centerline length) were compared across modalities, with segmentations performed at peak systole (CTA, 4D flow CMR) and end-diastole (mDIXON).

Main Results:

  • High agreement (Intraclass Correlation Coefficients [ICCs] 0.68-0.97) was observed between 4D flow CMR and CTA/mDIXON for maximum diameter, volume, and centerline length.
  • Agreement between 4D flow CMR and CTA was good to excellent (ICCs 0.70-0.97).
  • Agreement between mDIXON and CTA was very good to excellent (ICCs 0.87-0.96).
  • Statistically significant differences were minimal, noted only for maximum diameter in the ascending aorta (CTA vs. mDIXON) and volume in the aortic arch (CTA vs. 4D flow CMR).

Conclusions:

  • Morphological parameters derived from 4D flow CMR segmentations show high agreement with CTA and mDIXON in patients with various aortic pathologies.
  • 4D flow CMR holds promise for evaluating both aortic morphology and hemodynamics in a single imaging session.
  • Further validation in larger cohorts is recommended to establish 4D flow CMR as a single-modality imaging technique.
Abstract

Keywords:
4D flow CMRAortaCTAMorphologymDIXON

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