Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance
Background: Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) shows promise for quantifying mitral regurgitation (MR) by allowing for direct regurgitant volume (RVol) measurement using a plane precisely placed at the MR jet. However, the ideal location of a measurement plane remains...
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Elsevier
2025-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664725000092 |
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| author | Adarsh Aratikatla Taimur Safder Gloria Ayuba Vinesh Appadurai Aakash Gupta Michael Markl James Thomas Jeesoo Lee |
| author_facet | Adarsh Aratikatla Taimur Safder Gloria Ayuba Vinesh Appadurai Aakash Gupta Michael Markl James Thomas Jeesoo Lee |
| author_sort | Adarsh Aratikatla |
| collection | DOAJ |
| description | Background: Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) shows promise for quantifying mitral regurgitation (MR) by allowing for direct regurgitant volume (RVol) measurement using a plane precisely placed at the MR jet. However, the ideal location of a measurement plane remains unclear. This study aims to systematically examine how varying measurement locations affect RVol quantification and determine the optimal location using the momentum conservation principle of a free jet. Methods: Patients diagnosed with MR by transthoracic echocardiography (TTE) and scheduled for CMR were prospectively recruited. Regurgitant jet flow volume (RVoljet) and regurgitant jet flow momentum (RMomjet) were quantified using 4D flow CMR at seven locations along the jet axis, x. The reference plane (mid-plane, x = 0 mm) was positioned at the peak velocity of the jet at each cardiac phase, and three additional planes were positioned on either side of the jet, each 2.5 mm apart. RVoljet was compared to RVolTTE, measured by the proximal isovelocity surface area method, and RVolindirect, measured by subtracting aortic forward flow volume from the left ventricle stroke volume derived from two-dimensional phase contrast at the aortic valve and a stack of short-axis cine CMR techniques. Results: RVoljet and RMomjet were quantified in 45 patients (age 63±13, male 26). In patients with RVoljet at x = 0 mm ≥ 10 mL (n = 25), RVoljet consistently increased as the plane moved downstream. RVoljet measured furthest upstream (x = −7.5 mm) was significantly lower (39±11%, p<0.001) and RVoljet measured furthest downstream (x = 7.5 mm) was significantly higher (16±19%, p<0.001) than RVoljet at x = 0 mm. RMomjet similarly increased from x = −7.5 to 0 mm (57±12%, p<0.001) but stabilized from x = 0–7.5 mm (−2±17%). From x = −7.5 to 7.5 mm, RVoljet was in consistent moderate agreement with RVolindirect (n = 41, bias = −2±24 to 8±32 mL, intraclass correlation coefficient = 0.55–0.63, p<0.001). Conclusion: The location of a measurement plane significantly influences RVol quantification using the direct 4D flow CMR approach. Based on the converging profile of RMomjet, we propose the peak velocity of the jet as the optimal position. |
| format | Article |
| id | doaj-art-ec82222340d54bca87dd966ff7a0fef9 |
| institution | DOAJ |
| issn | 1097-6647 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-ec82222340d54bca87dd966ff7a0fef92025-08-20T03:10:20ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472025-01-0127110184710.1016/j.jocmr.2025.101847Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonanceAdarsh Aratikatla0Taimur Safder1Gloria Ayuba2Vinesh Appadurai3Aakash Gupta4Michael Markl5James Thomas6Jeesoo Lee7School of Medicine, The Royal College of Surgeons in Ireland, Dublin, IrelandDivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USADivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USADivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USADepartment of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USADepartment of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USADivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USADepartment of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Corresponding author.Background: Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) shows promise for quantifying mitral regurgitation (MR) by allowing for direct regurgitant volume (RVol) measurement using a plane precisely placed at the MR jet. However, the ideal location of a measurement plane remains unclear. This study aims to systematically examine how varying measurement locations affect RVol quantification and determine the optimal location using the momentum conservation principle of a free jet. Methods: Patients diagnosed with MR by transthoracic echocardiography (TTE) and scheduled for CMR were prospectively recruited. Regurgitant jet flow volume (RVoljet) and regurgitant jet flow momentum (RMomjet) were quantified using 4D flow CMR at seven locations along the jet axis, x. The reference plane (mid-plane, x = 0 mm) was positioned at the peak velocity of the jet at each cardiac phase, and three additional planes were positioned on either side of the jet, each 2.5 mm apart. RVoljet was compared to RVolTTE, measured by the proximal isovelocity surface area method, and RVolindirect, measured by subtracting aortic forward flow volume from the left ventricle stroke volume derived from two-dimensional phase contrast at the aortic valve and a stack of short-axis cine CMR techniques. Results: RVoljet and RMomjet were quantified in 45 patients (age 63±13, male 26). In patients with RVoljet at x = 0 mm ≥ 10 mL (n = 25), RVoljet consistently increased as the plane moved downstream. RVoljet measured furthest upstream (x = −7.5 mm) was significantly lower (39±11%, p<0.001) and RVoljet measured furthest downstream (x = 7.5 mm) was significantly higher (16±19%, p<0.001) than RVoljet at x = 0 mm. RMomjet similarly increased from x = −7.5 to 0 mm (57±12%, p<0.001) but stabilized from x = 0–7.5 mm (−2±17%). From x = −7.5 to 7.5 mm, RVoljet was in consistent moderate agreement with RVolindirect (n = 41, bias = −2±24 to 8±32 mL, intraclass correlation coefficient = 0.55–0.63, p<0.001). Conclusion: The location of a measurement plane significantly influences RVol quantification using the direct 4D flow CMR approach. Based on the converging profile of RMomjet, we propose the peak velocity of the jet as the optimal position.http://www.sciencedirect.com/science/article/pii/S1097664725000092Valvular regurgitationMitral regurgitationMitral valve disease4D flow CMR4D flow MRI |
| spellingShingle | Adarsh Aratikatla Taimur Safder Gloria Ayuba Vinesh Appadurai Aakash Gupta Michael Markl James Thomas Jeesoo Lee Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance Journal of Cardiovascular Magnetic Resonance Valvular regurgitation Mitral regurgitation Mitral valve disease 4D flow CMR 4D flow MRI |
| title | Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance |
| title_full | Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance |
| title_fullStr | Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance |
| title_full_unstemmed | Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance |
| title_short | Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance |
| title_sort | impact of measurement location on direct mitral regurgitation quantification using four dimensional flow cardiovascular magnetic resonance |
| topic | Valvular regurgitation Mitral regurgitation Mitral valve disease 4D flow CMR 4D flow MRI |
| url | http://www.sciencedirect.com/science/article/pii/S1097664725000092 |
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