4d flow imaging for anatomic lesions - nasci flow for anatomic leisons... · lpch stanford...

LPCH Stanford University

4D Flow Imaging for Anatomic Lesions

Albert Hsiao, MD, PhD

Fellow, Interventional Radiology Department of Radiology

Stanford University


Translating 4D Phase-Contrast MRI from Curiosity to Clinical Practice


Disclosures

� Founder, Morpheus Medical


Introduction � Congenital heart MRI examination

� SSFP, 2DPC, MRA � Labor-intensive, technically-demanding exam

4D Flow for Anatomic Lesions


� 4D phase-contrast (4DPC, 4D Flow) MRI � Volumetric, time-resolved vector field

Visualization Approaches


Markl, et al. JCVMR 2011 13:7

15-30 min, limited FOV acquisition


Parallel-imaging with compressed-sensing

Compressed-Sensing ARC/GRAPPA


Hsiao, et al. Radiology 2012 Aug 24.


� Improved image quality for the same acquisition time. � 1.5T

Parallel-imaging with compressed-sensing

Compressed-Sensing ARC/GRAPPA

MPR

Vo

lum

e-re

nder

ing


10 minute, 1-mm3 near-isotropic

full FOV acquisition



� 4D phase-contrast (4DPC, 4D Flow) MRI � Volumetric, time-resolved vector field

Compressed-sensing facilitates volumetric visualization



Valvular insufficiency Velocity-overlay volume-rendering

PulmonicAortic

Tricuspid Mitral




Valvular insufficiency Interobserver agreement

� Very high agreement between observers � Slightly greater sensitivity of second observer

present absent

present 23 1

absent 5 94

Obs

erve

r 1

Observer 2

κ=0.87




Valvular insufficiency Intermodality agreement

present absent

present 21 3

absent 7 92

Obs

erve

r 1

ECHO ≥mild

present absent

present 23 5

absent 5 90

Obs

erve

r 2

ECHO ≥mild

present absent

present 14 10

absent 0 99

Obs

erve

r 1

ECHO >mild

present absent

present 14 14

absent 0 95

Obs

erve

r 2

ECHO >mild

κ=0.77

κ=0.69 κ=0.76

κ=0.61




Intracardiac shunts ASD




Intracardiac shunts VSD




Intracardiac shunts VSD patch leak

10 year-old boy with pulmonary atresia with VSD, post-repair. Hsiao, et al. Radiology 2012 Aug 24.



Intracardiac shunts Intraventricular aortic baffle leak

3 year-old girl with dextrocardia, cc-TGA, DORV post-Rastelli and hemi-Mustard atrial switch.




Intracardiac shunts 1.5-Ventricle Repair



Intracardiac shunts 1.5-Ventricle Repair

1.5-ventricle repair with VSD patch leak



Intracardiac shunts Left atrial baffle leak

TGA



Extracardiac shunts PAPVR




Summary

� 4D Phase-Contrast (4D Flow) MRI � Can be performed as a single accelerated 10 minute

acquisition. � Facilitates visualization of anatomic lesions. � Facilitates quantitative assessment of blood flow. � Facilitates quantitative assessment of ventricular

size and function.



Acknowledgements

� NVIDIA � Lucas Foundation � Morgridge Foundation � GE Healthcare � NIH R01 EB009690


Thank you

4d flow imaging for anatomic lesions - nasci flow for anatomic leisons... · lpch stanford...

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