LPCH Stanford University
4D Flow Imaging for Anatomic Lesions
Albert Hsiao, MD, PhD
Fellow, Interventional Radiology Department of Radiology
Stanford University
LPCH Stanford University
Translating 4D Phase-Contrast MRI from Curiosity to Clinical Practice
LPCH Stanford University
Disclosures
� Founder, Morpheus Medical
LPCH Stanford University
Introduction � Congenital heart MRI examination
� SSFP, 2DPC, MRA � Labor-intensive, technically-demanding exam
4D Flow for Anatomic Lesions
LPCH Stanford University
� 4D phase-contrast (4DPC, 4D Flow) MRI � Volumetric, time-resolved vector field
Visualization Approaches
4D Flow for Anatomic Lesions
Markl, et al. JCVMR 2011 13:7
15-30 min, limited FOV acquisition
LPCH Stanford University
Parallel-imaging with compressed-sensing
Compressed-Sensing ARC/GRAPPA
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
LPCH Stanford University
� 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
4D Flow for Anatomic Lesions
10 minute, 1-mm3 near-isotropic
full FOV acquisition
Hsiao, et al. Radiology 2012 Aug 24.
LPCH Stanford University
� 4D phase-contrast (4DPC, 4D Flow) MRI � Volumetric, time-resolved vector field
Compressed-sensing facilitates volumetric visualization
4D Flow for Anatomic Lesions
LPCH Stanford University
Valvular insufficiency Velocity-overlay volume-rendering
PulmonicAortic
Tricuspid Mitral
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
LPCH Stanford University
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
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
LPCH Stanford University
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
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
LPCH Stanford University
Intracardiac shunts ASD
Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
LPCH Stanford University
Intracardiac shunts VSD
Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
LPCH Stanford University
Intracardiac shunts VSD patch leak
10 year-old boy with pulmonary atresia with VSD, post-repair. Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
LPCH Stanford University
Intracardiac shunts Intraventricular aortic baffle leak
3 year-old girl with dextrocardia, cc-TGA, DORV post-Rastelli and hemi-Mustard atrial switch.
Hsiao, et al. Radiology 2012 Aug 24.
4D Flow for Anatomic Lesions
LPCH Stanford University
Intracardiac shunts 1.5-Ventricle Repair
4D Flow for Anatomic Lesions
LPCH Stanford University
Intracardiac shunts 1.5-Ventricle Repair
1.5-ventricle repair with VSD patch leak
4D Flow for Anatomic Lesions
LPCH Stanford University
Intracardiac shunts Left atrial baffle leak
TGA
4D Flow for Anatomic Lesions
LPCH Stanford University
Extracardiac shunts PAPVR
4D Flow for Anatomic Lesions
Hsiao, et al. Radiology 2012 Aug 24.
LPCH Stanford University
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.
4D Flow for Anatomic Lesions
LPCH Stanford University
Acknowledgements
� NVIDIA � Lucas Foundation � Morgridge Foundation � GE Healthcare � NIH R01 EB009690
LPCH Stanford University
Thank you
Top Related