Background The prevalence of valvular aortic stenosis (AS) increases as the population ages. Echocardiographic measurements of peak jet velocity (V-peak), mean pressure gradient (P-mean), and... Show moreBackground The prevalence of valvular aortic stenosis (AS) increases as the population ages. Echocardiographic measurements of peak jet velocity (V-peak), mean pressure gradient (P-mean), and aortic valve area (AVA) determine AS severity and play a pivotal role in the stratification towards valvular replacement. A multimodality imaging approach might be needed in cases of uncertainty about the actual severity of the stenosis. Purpose To compare four-dimensional phase-contrast magnetic resonance (4D PC-MR), two-dimensional (2D) PC-MR, and transthoracic echocardiography (TTE) for quantification of AS. Study Type Prospective. Population Twenty patients with various degrees of AS (69.3 +/- 5.0 years). Field Strength/Sequences 4D PC-MR and 2D PC-MR at 3T. Assessment We compared V-peak, P-mean, and AVA between TTE, 4D PC-MR, and 2D PC-MR. Flow eccentricity was quantified by means of normalized flow displacement, and its influence on the accuracy of TTE measurements was investigated. Statistical Tests Pearson's correlation, Bland-Altman analysis, paired t-test, and intraclass correlation coefficient. Results 4D PC-MR measured higher V-peak (r = 0.95, mean difference + 16.4 +/- 10.7%, P <0.001), and P-mean (r = 0.92, mean difference + 14.9 +/- 16.0%, P = 0.013), but a less critical AVA (r = 0.80, mean difference + 19.9 +/- 20.6%, P = 0.002) than TTE. In contrast, unidirectional 2D PC-MR substantially underestimated AS severity when compared with TTE. Differences in V-peak between 4D PC-MR and TTE showed to be strongly correlated with the eccentricity of the flow jet (r = 0.89, P <0.001). Use of 4D PC-MR improved the concordance between V-peak and AVA (from 0.68 to 0.87), and between PG(mean) and AVA (from 0.68 to 0.86). Data Conclusion 4D PC-MR improves the concordance between the different AS parameters and could serve as an additional imaging technique next to TTE. Future studies should address the potential value of 4D PC-MR in patients with discordant echocardiographic parameters. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019. Show less
Gotschy, A.; Saguner, A.M.; Niemann, M.; Hamada, S.; Akdis, D.; Yoon, J.N.; ... ; Manka, R. 2018
