Patient‐specific requirements and clinical validation of MRI‐based pressure mapping: A two‐center study in patients with aortic coarctation

• Published in: Journal of magnetic resonance imaging 2019-01, Vol.49 (1), p.81-89
• Main Authors: Goubergrits, Leonid, Hellmeier, Florian, Neumann, Dominik, Mihalef, Viorel, Gulsun, Mehmet A., Chinali, Marcello, Secinaro, Aurelio, Runte, Kilian, Schubert, Stephan, Berger, Felix, Kuehne, Titus, Hennemuth, Anja, Kelm, Marcus
• Format: Article
• Language: English
• Subjects: 4D VEC MRI; Adolescent; Adult; Aorta; aortic coarctation; Aortic Coarctation - diagnostic imaging; Cardiac Catheterization; Catheterization; Catheters; Child; Coding; congenital heart disease; Diagnostic systems; Equivalence; Female; Heart; Heart - diagnostic imaging; Humans; Image processing; Image Processing, Computer-Assisted - methods; Image resolution; image‐based cardiovascular modeling; Imaging, Three-Dimensional - methods; In vivo methods and tests; Intubation; Magnetic Resonance Imaging; Male; Mapping; Mathematical analysis; Medical imaging; Medical instruments; Middle Aged; noninvasive diagnostics; Patients; Peak pressure; Poisson Distribution; Poisson equation; Population studies; Pressure; Pressure drop; Pressure gradients; Prospective Studies; Reproducibility of Results; Risk; Spatial data; Spatial discrimination; Spatial resolution; Stenosis; Temporal resolution; Young Adult
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.26230

Background Invasive peak‐to‐peak pressure gradients are the current clinical reference standard for assessing aortic coarctation. To obtain them, patients need to undergo arterial heart catheterization. Unless an intervention is performed, the procedure remains purely diagnostic, while the concomitant risks remain. Purpose To validate MRI‐based pressure mapping against pressure drop derived from heart catheterization and to define minimal clinical requirements. Study Type Prospective clinical validation study. Population Twenty‐seven coarctation patients with an indicated heart catheterization were enrolled at two clinical centers. MRI Sequences 1.5T including 4D velocity‐encoded MRI and 3D anatomical imaging of the aorta. Assessment Pressure drop across the stenosis was calculated by pressure mapping based on the pressure Poisson equation. Calculated pressure drops were compared with catheter measured data. Spatial and temporal resolution were analyzed using in silico phantom‐based data as well as in vivo measurements. Statistics Pressure drop was compared to peak‐to‐peak measurements. A two‐sample paired mean equivalence test was used. Results In patients without imaging artifacts and a required spatial resolution ≥5 voxel/diameter, significant equivalence of pressure mapping compared to heart catheterization was found (17.5 ± 6.49 vs. 16.6 ± 6.53 mmHg, P