Assessment of Regional Myocardial Velocities by Tissue Phase Mapping and Feature Tracking in Healthy Children and Pediatric Patients with Hypertrophic Cardiomyopathy: A Comparison Study
Alexander Ruh1, Arleen Li2, Joshua D Robinson1,3,4, Cynthia K Rigsby1,4,5, and Michael Markl1,6

1Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States, 2Feinberg School of Medicine, Northwestern University, Chicago, IL, United States, 3Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States, 4Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States, 5Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States, 6Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, United States


In this study, we compare tissue phase mapping (TPM) and feature tracking (FT) of standard cine SSFP images for the assessment of regional myocardial velocities in 15 pediatric patients with hypertrophic cardiomyopathy (HCM) and 20 age-matched healthy controls. Data analysis included the calculation of segmental (AHA 16-segment model) left ventricular radial and long-axis peak velocities in systole and diastole. Both techniques detected significantly decreased diastolic velocities in HCM patients compared to controls, suggesting reduced myocardial relaxation despite normal ejection fraction. Lower temporal resolution of FT derived velocities resulted in systematically lower peak velocities compared to directly measured TPM velocities.


Tissue Phase Mapping (TPM) is a well-established technique to quantify myocardial velocities1-4 and has been successfully applied for the detection of regional left ventricular (LV) abnormalities in cardiac pathologies such as hypertensive heart disease, cardiomyopathy, or after heart transplantation.5-9 Recently, the development of feature tracking (FT) algorithms has enabled the retrospective quantification of myocardial strain and velocities from standard 2D cine SSFP images.10-15 An advantage of FT is that it does not require additional MRI sequences, but it can derive functional information based on standard-of-care images. Hypertrophic cardiomyopathy (HCM) is a common genetic condition characterized by otherwise unexplained increased LV wall thickness and associated with increased risk of heart failure, atrial fibrillation, and sudden death.16 MR techniques (tagging, FT) have demonstrated reduced LV myocardial function in patients with HCM despite normal LV ejection fraction (LVEF),11-13,17,18 but to the best of our knowledge no comparison between different MRI techniques has been performed. In this study, we systematically evaluated the performance of TPM and FT for the assessment of regional LV myocardial velocities in pediatric patients with HCM compared to healthy controls.


Fifteen pediatric HCM patients (15±4y, 9f) and 20 age-matched controls (16±4y [p=0.6], 10f) underwent standard CMR (1.5T Siemens Aera) including k-t accelerated (R=5) TPM using a prospectively gated, black-blood prepared phase-contrast sequence with 3-directional velocity encoding1,6,19 in short-axis orientation (base, mid, apex; each in one breath-hold; in-plane resolution = (1.6-2.5 mm)2; temporal resolution = 21-25 ms). FT analysis was performed on standard short- (base, mid, apex) and long-axis (2, 3 and 4 chamber views) retrospectively gated cine SSFP images (in-plane resolution = (0.7-1.1 mm)2; true temporal resolution = 30±5 ms) using commercially available software (TomTec ImageArena). For TPM data analysis an in-house developed MATLAB tool was used to manually segment LV endo-/epicardial contours and to transform the measured Cartesian velocities (vx,vy,vz) to radial (vr), circumferential (vΦ) and long-axis (vz) velocity components more closely resembling LV contraction, rotation, and shortening. For both FT and TPM the AHA 16-segment model was used to obtain systolic and diastolic, radial and long-axis peak velocities for each segment (Fig. 1). For 5 controls and 3 patients not all cine long-axis views have been acquired resulting in incomplete FT segmental information. Thus, these subjects had to be excluded for long-axis analysis.


Table 1 lists global LV peak velocities (averaged over all segments) showing significantly reduced diastolic radial and long-axis peak velocities for HCM patients using both TPM (p<0.01) and FT (only vz significant with p<0.05), while LVEF in HCM patients was normal (65±8%). These global differences in diastolic peak velocities were also present on the segmental level as depicted in Fig. 2. Although both TPM and FT showed significant differences between HCM patients and controls on the global and regional level, peak velocities obtained from FT were generally lower compared to TPM. Bland-Altman analysis comparing FT with TPM regional velocities (Fig. 3) demonstrated a systematic underestimation for FT compared to TPM with an increasing difference for higher peak velocities. Nevertheless, there were significant correlations between the segmental radial and long-axis peak velocities (systole and diastole) obtained from both techniques, 0.44<r<0.65 with p<0.001.


While two previous FT studies on children only investigated systolic strain / strain rate,11,13 the present study is the first to assess diastolic function in pediatric HCM patients via radial and long-axis peak velocities. Here, both TPM and FT demonstrate reduced diastolic function in patients, which is in agreement with previous studies on adults.12,18 However, the derived FT velocities are systematically lower than the directly measured TPM velocities. This underestimation might be explained by enhanced temporal averaging for FT. First, the temporal resolution of the cine images is lower (30±5ms vs. 23.5±0.6ms for TPM), and second, more importantly, the FT algorithm needs at least two time points to derive one velocity value, whereas TPM directly measures the velocity for each time point. Thus, the effective temporal resolution for FT velocities is more than two times lower than for TPM. For future studies it might be beneficial to use high temporal resolution cine images20 for FT applications


Both TPM and FT show decreased diastolic myocardial velocities in HCM patients, suggesting reduced myocardial relaxation despite normal LVEF. This may be an early indicator of disease and helpful in multiparametric HCM patient analysis. This study further shows that FT systematically underestimates myocardial velocities compared to directly measured TPM velocities. This implies that a quantitative comparison of velocities obtained from different techniques needs to be treated carefully.


Grant support by the National Institute of Heart, Lung and Blood Disorders (NHLBI) R01 HL 117888.


1. Hennig J, Schneider B, Peschl S, Markl M, Laubenberger TKJ. Analysis of Myocardial Motion Based on Velocity Measurements with a Black Blood Prepared Segmented Gradient-Echo Sequence: Methodology and Applications to Normal Volunteers and Patients. J Magn Reson Imaging. 1998;8:868–77.

2. Jung B, Föll D, Böttler P, Petersen S, Hennig J, Markl M. Detailed Analysis of Myocardial Motion in Volunteers and Patients Using High-Temporal-Resolution MR Tissue Phase Mapping. J Magn Reson Imaging. 2006;24:1033–9.

3. Föll D, Jung B, Schilli E, Staehle F, Geibel A, Hennig J, et al. Magnetic Resonance Tissue Phase Mapping of Myocardial Motion: New Insight in Age and Gender. Circ Cardiovasc Imaging. 2010;3:54–64.

4. Lin K, Chowdhary V, Benzuly KH, Yancy CW, Lomasney JW, Rigolin VH, et al. Reproducibility and observer variability of tissue phase mapping for the quantification of regional myocardial velocities. Int J Cardiovasc Imaging. 2016;32:1227–34.

5. Foell D, Jung B, Germann E, Staehle F, Bode C, Markl M. Hypertensive heart disease: {MR} tissue phase mapping reveals altered left ventricular rotation and regional myocardial long-axis velocities. Eur Radiol. 2013;23:339–47.

6. Markl M, Rustogi R, Galizia M, Goyal A, Collins J, Usman A, et al. Myocardial T2-Mapping and Velocity Mapping: Changes in Regional Left Ventricular Structure and Function after Heart Transplantation. Magn Reson Med. 2013;70:517–26.

7. Collins J, Sommerville C, Magrath P, Spottiswoode B, Freed BH, Benzuly KH, et al. Extracellular Volume Fraction Is More Closely Associated With Altered Regional Left Ventricular Velocities Than Left Ventricular Ejection Fraction in Nonischemic Cardiomyopathy. Circ Cardiovasc Imaging. 2014;8:e001998.

8. von Knobelsdorff-Brenkenhoff F, Hennig P, Menza M, Dieringer MA, Foell D, Jung B, et al. Myocardial Dysfunction in Patients With Aortic Stenosis and Hypertensive Heart Disease Assessed by MR Tissue Phase Mapping. J Magn Reson Imaging. 2016;44:168–77.

9. Chang M-C, Wu M-T, Weng K-P, Su M-Y, Menza M, Huang H-C, et al. Left ventricular regional myocardial motion and twist function in repaired tetralogy of Fallot evaluated by magnetic resonance tissue phase mapping. Eur Radiol. 2017;doi:10.1007/s00330-017-4908-7.

10. Hor KN, Gottliebson WM, Carson C, Wash E, Cnota J, Fleck R, et al. Comparison of Magnetic Resonance Feature Tracking for Strain Calculation With Harmonic Phase Imaging Analysis. JACC Cardiovasc Imaging. 2010;3:144–51.

11. Smith BM, Dorfman AL, Yu S, Russell MW, Agarwal PP, Ghadimi Mahani M, et al. Relation of Strain by Feature Tracking and Clinical Outcome in Children, Adolescents, and Young Adults With Hypertrophic Cardiomyopathy. Am J Cardiol. 2014;114:1275–80.

12. Nucifora G, Muser D, Gianfagna P, Morocutti G, Proclemer A. Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosis. Int J Cardiovasc Imaging. 2015;31:1603–10.

13. Bogarapu S, Puchalski MD, Everitt MD, Williams R V., Weng HY, Menon SC. Novel Cardiac Magnetic Resonance Feature Tracking (CMR-FT) Analysis for Detection of Myocardial Fibrosis in Pediatric Hypertrophic Cardiomyopathy. Pediatr Cardiol. 2016;37:663–73.

14. Jing L, Wehner GJ, Suever JD, Charnigo RJ, Alhadad S, Stearns E, et al. Left and right ventricular dyssynchrony and strains from cardiovascular magnetic resonance feature tracking do not predict deterioration of ventricular function in patients with repaired tetralogy of Fallot. J Cardiovasc Magn Reson. 2016;18:49.

15. Orwat S, Diller G-P, Kempny A, Radke R, Peters B, Kühne T, et al. Myocardial deformation parameters predict outcome in patients with repaired tetralogy of Fallot. Heart. 2016;102:209–15.

16. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Aummary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:2761–96.

17. Young AA, Kramer CM, Ferrari VA, Axel L, Reichek N. Three-Dimensional Left Ventricular Deformation in Hypertrophic Cardiomyopathy. Circulation. 1994;90:854–67.

18. Ennis DB, Epstein FH, Kellman P, Fananapazir L, McVeigh ER, Arai AE. Assessment of Regional Systolic and Diastolic Dysfunction in Familial Hypertrophic Cardiomyopathy Using MR Tagging. Magn Reson Med. 2003;50:638–42.

19. Jung B, Honal M, Ullmann P, Hennig J, Markl M. Highly k-t-Space-Accelerated Phase-Contrast MRI. Magn Reson Med. 2008;60:1169–77.

20. Krishnamurthy R, Cheong B, Pednekar A, Muthupillai R. High-temporal resolution (<6 ms) Cine Steady-State Free Precession (SSFP) imaging for assessing LV diastolic function. J Cardiovasc Magn Reson. 2009;11(Suppl 1):P74.


Figure 1: Tissue phase mapping and feature tracking analysis. Both tools provide regional velocity time courses (16-segment AHA model; myocardial values were used from TomTec), from which systolic and diastolic peak velocities are obtained.

Table 1: Global LV peak velocities as well as diastolic basal peak velocities, averaged over all segments and all basal segments, respectively. For diastolic radial peak velocities a significant difference is only present in the basal slice, whereas all other components show significant differences for the global diastolic values. Five controls and 3 patients had to be excluded for long-axis analysis since not all cine long-axis views have been acquired for these subjects.

Figure 2: Bullseye plots for regional diastolic peak velocities. Asterisks mark significant differences between controls and HCM patients (* p<0.05, ** p<0.01). For TPM almost all segments for both radial and long-axis velocities are significantly different, whereas for FT there are only two significant segments for each component. This is also reflected in the global diastolic values, which are more significant for TPM and less or not significant for FT (Tab. 1). However, considering the average of all segments within one slice, the basal peak velocities from FT are both significantly reduced in patients (Tab. 1).

Figure 3: Bland-Altman analysis for the segmental peak velocities confirms the underestimation of velocities from FT compared to TPM. Dashed lines mark 95% confidence intervals and the oblique lines are least-square fits indicating an increased difference for higher velocities

Proc. Intl. Soc. Mag. Reson. Med. 26 (2018)