Automated vortical blood flow-based estimation of mean pulmonary arterial pressure from 4D flow MRI

Corina Kräuter, Ursula Reiter, Gabor Kovacs, Clemens Reiter, Marc Masana, Horst Olschewski, Michael Fuchsjäger, Rudolf Stollberger, Gert Reiter

Research output: Contribution to journalArticlepeer-review


PURPOSE: Elevated mean pulmonary arterial pressure (mPAP), or pulmonary hypertension (pH), is associated with vortical blood flow along the main pulmonary artery. We present and validate a method for automated detection and tracking of the PH-related vortex from magnetic resonance 4D flow data that allows estimation of mPAP.

METHODS: The proposed method detects the presence of a PH-related vortex in the main pulmonary artery based on geometrical properties of swirling streamlines and estimates mPAP from the PH-related vortex duration (tvortex) using a previously established model. 4D flow data of 32 subjects (19/13 with/without PH) who underwent right heart catheterization (RHC) for mPAP measurement and diagnosis of PH (mPAP >20 mmHg) were used to compare visual and automated PH-related vortex detection and to validate estimated mPAP against RHC-derived results.

RESULTS: Visually and automatically determined tvortex values correlated strongly (r = 0.98); they yielded no bias, and the standard deviation of differences between them was small (5.9% of the cardiac interval). mPAP estimates from visual and automated analyses both allowed diagnosis of PH with an area under the curve of 1.00 [0.89,1.00]. For subjects with PH, neither visually nor automatically estimated mPAP differed from mPAP measured by RHC, while the standard deviation between estimated and invasively measured mPAP was lower with visual estimation (3.1 mmHg vs. 5.3 mmHg).

CONCLUSION: An automated method for PH-related vortex detection and tracking from magnetic resonance 4D flow data was introduced, which demonstrated very good agreement with visual analysis and accurate estimation of elevated mPAP.

Original languageEnglish
Pages (from-to)132-141
Number of pages10
JournalMagnetic Resonance Imaging
Publication statusPublished - May 2022


  • 4D flow
  • Blood flow
  • Pulmonary arterial pressure
  • Pulmonary artery
  • Pulmonary hypertension
  • Vortex detection

ASJC Scopus subject areas

  • Biophysics
  • Radiology Nuclear Medicine and imaging
  • Biomedical Engineering


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