Quantitative evaluation of aortic valve regurgitation in 4D flow cardiac magnetic resonance: at which level should we measure?

Figures

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  Fig. 1. Measurement levels for aortic flow measurements. a: Level 1: below aortic valve, Level 2: at the aortic valve, Level 3: aortic sinus, Level 4: sinotubular junction, Level 5: ascending aorta at the level of the pulmonary arteries, Level 6: ascending aorta below the brachiocephalic trunk. b/c: 4D flow image at the level of the pulmonary arteries and visualization of the regurgitant aortic jet (arrow)

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  Fig. 2. Antegrade flow and net flow in aortic regurgitation. a: No significant difference was measured between the six different levels regarding antegrade flow. b: Aortic net flow was significantly higher below or at the level of the aortic valve compared to measurements above the valve and in the ascending aorta; the highest net flow was measured at the level of the aortic valve. AV Aortic valve, ST Sinotubular junction, PA Pulmonary arteries, BCT Brachiocephalic trunk

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  Fig. 3. Retrograde flow and regurgitant fraction in aortic regurgitation. Retrograde flow a as well as regurgitant fraction b were significantly lower below or at the level of the aortic valve compared to measurements above the valve and in the ascending aorta (level 3–6); the lowest retrograde flow and regurgitant fraction was measured at the level of the aortic valve. AV Aortic valve, ST Sinotubular junction, PA Pulmonary arteries, BCT Brachiocephalic trunk

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  Fig. 4. Inter-reader agreement of aortic regurgitation in level 1–6 visualized by Bland Altmann plots. Best inter-reader agreement and the narrowest limits of agreement were at the level of the pulmonary arteries. AV Aortic valve, ST Sinotubular junction, PA Pulmonary arteries, BCT Brachiocephalic trunk