Evaluation of 4D flow MRI-based non-invasive pressure assessment in aortic coarctations.
Severity of aortic coarctation (CoA) is currently assessed by estimating trans-coarctation pressure drops through cardiac catheterization or echocardiography. In principle, more detailed information could be obtained non-invasively based on space- and time-resolved magnetic resonance imaging (4D flow) data. Yet the limitations of this imaging technique require testing the accuracy of 4D flow-derived hemodynamic quantities against other methodologies. With the objective of assessing the feasibility and accuracy of this non-invasive method to support the clinical diagnosis of CoA, we developed an algorithm (4DF-FEPPE) to obtain relative pressure distributions from 4D flow data by solving the Poisson pressure equation. 4DF-FEPPE was tested against results from a patient-specific fluid-structure interaction (FSI) simulation, whose patient-specific boundary conditions were prescribed based on 4D flow data. Since numerical simulations provide noise-free pressure fields on fine spatial and temporal scales, our analysis allowed to assess the uncertainties related to 4D flow noise and limited resolution. 4DF-FEPPE and FSI results were compared on a series of cross-sections along the aorta. Bland-Altman analysis revealed very good agreement between the two methodologies in terms of instantaneous data at peak systole, end-diastole and time-averaged values: biases (means of differences) were +0.4 mmHg, -1.1 mmHg and +0.6 mmHg, respectively. Limits of agreement (2 SD) were ±0.978 mmHg, ±1.06 mmHg and ±1.97 mmHg, respectively. Peak-to-peak and maximum trans-coarctation pressure drops obtained with 4DF-FEPPE differed from FSI results by 0.75 mmHg and -1.34 mmHg respectively. The present study considers important validation aspects of non-invasive pressure difference estimation based on 4D flow MRI, showing the potential of this technology to be more broadly applied to the clinical practice.
['Saitta|Simone|S|', 'Pirola|Selene|S|', 'Piatti|Filippo|F|', 'Votta|Emiliano|E|', 'Lucherini|Federico|F|', 'Pluchinotta|Francesca|F|', 'Carminati|Mario|M|', 'Lombardi|Massimo|M|', 'Geppert|Christian|C|', 'Cuomo|Federica|F|', 'Figueroa|Carlos Alberto|CA|', 'Xu|Xiao Yun|XY|', 'Redaelli|Alberto|A|']
D000465:Algorithms D001011:Aorta D001017:Aortic Coarctation D001783:Blood Flow Velocity D006328:Cardiac Catheterization D005240:Feasibility Studies D020342:Finite Element Analysis D006439:Hemodynamics D006801:Humans D008279:Magnetic Resonance Imaging D008955:Models, Cardiovascular D066230:Patient-Specific Modeling D011312:Pressure D015203:Reproducibility of Results
Aortic coarctation Non-invasive pressure difference estimation 4D flow MRI Fluid dynamics Pressure Poisson equation