Comparison of Prospective and Retrospective Gated 4D Flow Cardiac MR Image Acquisitions in the Carotid Bifurcation

Abstract The superior temporal coverage of retrospective versus prospective gating in 4D flow cardiac MRI (cMRI) imaging offers advantages in comprehensively evaluating the hemodynamic environment across the complete cardiac cycle; however, retrospective acquisitions may result in temporal smoothing. Thus, the purpose of this study was to evaluate the agreement of 4D flow cMRI-derived bulk flow features and fluid (blood) velocities in the carotid bifurcation using prospective and retrospective gating techniques. Prospective and retrospective ECG-gated three-dimensional (3D) cine phase-contrast cardiac MRI with three-direction velocity encoding (i.e., 4D flow cMRI) data were acquired in ten carotid bifurcations from men (n = 3) and women (n = 2) that were cardiovascular disease-free. Velocity magnitude data were extracted from the fluid domain within the image volumes and evaluated across the entire volume or at defined anatomic planes (common, internal, external carotid arteries). Vector magnitudes were decomposed into components to quantify flow direction and disturbances, including retrograde flow. Flow streamlines encoded for velocity magnitude and velocity profiles were generated. Qualitative and quantitative agreement was observed in bulk flow features and fluid velocity magnitudes derived from either prospective or retrospective ECG-gated 4D flow cMRI. No significant differences in velocity magnitudes or components (υr, υθ, υz) were observed. Importantly, retrospective acquisitions captured increased retrograde flow in the internal carotid artery (i.e., carotid sinus) compared to prospective acquisitions. Prospective and retrospective ECG-gated 4D flow cMRI acquisitions provide comparable evaluations of the hemodynamic environment in the carotid bifurcation. However, the increased temporal coverage of retrospective acquisitions depicts disturbed blood flow patterns not captured by the prospective gating technique.