Cardiac MR assessment of aortic regurgitation: holodiastolic flow reversal in the descending aorta helps stratify severity

Radiology. 2011 Jul;260(1):98-104. doi: 10.1148/radiol.11102064. Epub 2011 Apr 7.


Purpose: To assess the utility of holodiastolic flow reversal (HDR) in the descending aorta on velocity-encoded cardiac magnetic resonance (MR) images in the stratification of aortic regurgitation (AR) severity.

Materials and methods: This study was approved by the institutional review board, with waiver of informed consent. A total of 80 patients (overall mean age, 49 years ± 18 [standard deviation]; 22 women and 58 men) with clinical indication for cardiac MR imaging of the aorta were analyzed retrospectively. Velocity-encoded MR imaging was used to quantify AR and assess for HDR at the level of the middescending aorta. These indexes were compared with a qualitative integrated echocardiographic evaluation of AR severity. Sensitivity and specificity for HDR in the prediction of substantial AR were determined, and logistic regression analysis (with associated odds ratios and C statistics) was performed, with HDR and regurgitant fraction as independent predictors. An additional 42 patients (overall mean age, 48 years ± 21; 12 female and 30 male) were then prospectively evaluated in similar fashion to evaluate a decision model derived from analysis of the first group.

Results: HDR predicted severe AR (echo grade, 4) with high sensitivity (100%) and specificity (93%). HDR was highly specific (100%) but had lower sensitivity (61%) for moderate to severe AR (echo grade, 3-4). Integration of HDR and direct AR quantification into a combined stratification model based on analysis of the primary group showed good predictive results in the validation group, with a C statistic of 0.94 for moderate to severe AR and 0.93 for severe AR.

Conclusion: HDR in the middescending thoracic aorta observed at cardiac MR is indicative of severe AR and can be used in conjunction with quantified regurgitant values obtained from velocity-encoded MR imaging to stratify AR severity.

Publication types

  • Comparative Study

MeSH terms

  • Aorta / diagnostic imaging
  • Aorta / pathology*
  • Aortic Valve Insufficiency / diagnostic imaging
  • Aortic Valve Insufficiency / pathology*
  • Female
  • Humans
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging, Cine / methods*
  • Male
  • Middle Aged
  • Myocardial Perfusion Imaging
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography