Evaluation of 4D flow MRI-based non-invasive pressure assessment in aortic coarctations

Simone Saitta, Selene Pirola, Filippo Piatti, Emiliano Votta, Federico Lucherini, Francesca Pluchinotta, Mario Carminati, Massimo Lombardi, Christian Geppert, Federica Cuomo, Carlos Alberto Figueroa, Xiao Yun Xu, Alberto Redaelli

Research output: Contribution to journalArticle


Severity of aortic coarctation (CoA) is currently assessed by estimating trans-coarctation pressure drops through cardiac catheterization or echocardiography. In principle, more detailed information could be obtained non-invasively based on space- and time-resolved magnetic resonance imaging (4D flow) data. Yet the limitations of this imaging technique require testing the accuracy of 4D flow-derived hemodynamic quantities against other methodologies. With the objective of assessing the feasibility and accuracy of this non-invasive method to support the clinical diagnosis of CoA, we developed an algorithm (4DF-FEPPE) to obtain relative pressure distributions from 4D flow data by solving the Poisson pressure equation. 4DF-FEPPE was tested against results from a patient-specific fluid-structure interaction (FSI) simulation, whose patient-specific boundary conditions were prescribed based on 4D flow data. Since numerical simulations provide noise-free pressure fields on fine spatial and temporal scales, our analysis allowed to assess the uncertainties related to 4D flow noise and limited resolution. 4DF-FEPPE and FSI results were compared on a series of cross-sections along the aorta. Bland-Altman analysis revealed very good agreement between the two methodologies in terms of instantaneous data at peak systole, end-diastole and time-averaged values: biases (means of differences) were +0.4 mmHg, −1.1 mmHg and +0.6 mmHg, respectively. Limits of agreement (2 SD) were ±0.978 mmHg, ±1.06 mmHg and ±1.97 mmHg, respectively. Peak-to-peak and maximum trans-coarctation pressure drops obtained with 4DF-FEPPE differed from FSI results by 0.75 mmHg and −1.34 mmHg respectively. The present study considers important validation aspects of non-invasive pressure difference estimation based on 4D flow MRI, showing the potential of this technology to be more broadly applied to the clinical practice.

Original languageEnglish
Pages (from-to)13-21
Number of pages9
JournalJournal of Biomechanics
Publication statusPublished - Sep 20 2019


  • 4D flow MRI
  • Aortic coarctation
  • Fluid dynamics
  • Non-invasive pressure difference estimation
  • Pressure Poisson equation

ASJC Scopus subject areas

  • Biophysics
  • Orthopedics and Sports Medicine
  • Biomedical Engineering
  • Rehabilitation

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