Published online October 17, 2002, 10.1148/rg.e9
Evaluation of Cardiac Valvular Disease with MR Imaging: Qualitative and Quantitative Techniques1
James F. Glockner, MD, PhD,
Donald L Johnston, MD and
Kiaran P McGee, PhD
1 From the Departments of Radiology (J.F.G., K.P.M.) and Cardiology (D.L.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55901. Presented as a scientific exhibit at the 2001 RSNA scientific assembly. Received March 25, 2002, revision requested July 11, revision received and accepted September 14. Address correspondence to J.F.G. (e-mail: glockner.james{at}mayo.edu
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Figure 1a. (a) Schematic and (b) pathologic views of the fibrous skeleton of the heart. The aortic valve is wedged between the mitral and tricuspid valves; the pulmonic valve is most anterior.
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Figure 1b. (a) Schematic and (b) pathologic views of the fibrous skeleton of the heart. The aortic valve is wedged between the mitral and tricuspid valves; the pulmonic valve is most anterior.
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Figure 2. Four-chamber view of the mitral and tricuspid valves.
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Figure 3a. (a) Normal aortic valve, closed (left) and open. (b) Calcified, degenerative bicuspid valve.
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Figure 3b. (a) Normal aortic valve, closed (left) and open. (b) Calcified, degenerative bicuspid valve.
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Figure 4. LV hypertrophy in a patient with long-standing aortic stenosis.
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Figure 5a. A four-chamber view is prescribed from the sagittal scout by positioning a section passing through the (a) LV apex and (b) mitral valve plane.
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Figure 5b. A four-chamber view is prescribed from the sagittal scout by positioning a section passing through the (a) LV apex and (b) mitral valve plane.
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Figure 6. The four-chamber view is used to prescribe short-axis views perpendicular to the long axis of the left ventricle.
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Figure 7. Short-axis view near the base is used to prescribe a plane through the aortic outflow tract to generate the three-chamber view.
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Figure 8a. The three-chamber view (a) is then used to prescribe sections through the valve plane (b).
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Figure 8b. The three-chamber view (a) is then used to prescribe sections through the valve plane (b).
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Figure 9a. (a) Magnitude and (b) phase images from a cine phase-contrast sequence through the proximal main pulmonary artery. Magnitude images are used to trace the vessel contour for each phase (there are good software programs that have automated this process to a large extent). The velocity information in the phase images can then be used to generate plots of (c) velocity versus time and (d) flow versus time.
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Figure 9b. (a) Magnitude and (b) phase images from a cine phase-contrast sequence through the proximal main pulmonary artery. Magnitude images are used to trace the vessel contour for each phase (there are good software programs that have automated this process to a large extent). The velocity information in the phase images can then be used to generate plots of (c) velocity versus time and (d) flow versus time.
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Figure 9c. (a) Magnitude and (b) phase images from a cine phase-contrast sequence through the proximal main pulmonary artery. Magnitude images are used to trace the vessel contour for each phase (there are good software programs that have automated this process to a large extent). The velocity information in the phase images can then be used to generate plots of (c) velocity versus time and (d) flow versus time.
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Figure 9d. (a) Magnitude and (b) phase images from a cine phase-contrast sequence through the proximal main pulmonary artery. Magnitude images are used to trace the vessel contour for each phase (there are good software programs that have automated this process to a large extent). The velocity information in the phase images can then be used to generate plots of (c) velocity versus time and (d) flow versus time.
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Figure 10. Flow curve through the proximal aorta in patient with aortic insufficiency. Regurgitant volume (RV) is the area under the time-flow curve below zero (A). Regurgitant fraction (RF) represents the ratio of regurgitant flow to forward flow (A/B).
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Figure 11. Prescription of a cine phase-contrast section at the level of the coronary ostia to measure regurgitant volume.
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Figure 12. Phase (left) and magnitude images from section just above stenotic valve. Red region of interest depicts entire aorta. Green pixels represent the peak velocity of the flow jet.
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Figure 13. Time-velocity curves from regions depicted in Figure 12 (colors correspond). A peak velocity of 340 cm/sec corresponds to a peak pressure gradient of 46 mm Hg.
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Figure 14. Single frame from cine sequence through stenotic aortic valve used to measure valve area. This frame represents the maximal area of the open valve (blue outline). High-resolution images and multiple thin sections are important for accurate and reproducible results. Phase-contrast images can also be used to estimate valve area.
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Copyright © 2003 by the Radiological Society of North America.
