3D phase contrast MRI: Partial volume correction for robust blood flow quantification in small intracranial vessels.

PURPOSE: Recent advances in 3D-PCMRI (phase contrast MRI) sequences allow for measuring the complex hemodynamics in cerebral arteries. However, the small size of these vessels vs spatial resolution can lead to non-negligible partial volume artifacts, which must be taken into account when computing blood flow rates. For this purpose, we combined the velocity information provided by 3D-PCMRI with vessel geometry measured with 3DTOF (time of flight MRI) or 3DRA (3D rotational angiography) to correct the partial volume effects in flow rate assessments. METHODS: The proposed methodology was first tested in vitro on cylindrical and patient specific vessels subject to fully controlled pulsatile flows. Both 2D- and 3D-PCMRI measurements using various spatial resolutions ranging from 20 to 1.3 voxels per vessel diameter were analyzed and compared with flowmeter baseline. Second, 3DTOF, 2D- and 3D-PCMRI measurements were performed in vivo on 35 patients harboring internal carotid artery (ICA) aneurysms indicated for endovascular treatments requiring 3DRA imaging. RESULTS: The in vitro 2D- and 3D-PCMRI mean flow rates assessed with partial volume correction showed very low sensitivity to the acquisition resolution above ≈2 voxels per vessel diameter while uncorrected flow rates deviated critically when decreasing the spatial resolution. 3D-PCMRI flow rates measured in vivo in ICA agreed very well with 2D-PCMRI data and a good flow conservation was observed at the C7 bifurcation. Globally, partial volume correction led to 10-15% lower flow rates than uncorrected values as those reported in most of the published studies on intracranial flows. CONCLUSION: Partial volume correction may improve the accuracy of PCMRI flow rate measurements especially in small vessels such as intracranial arteries. Magn Reson Med 79:129-140, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Assessing a heterogeneous model for accounting for endovascular devices in hemodynamic simulations of cerebral aneurysms.

The heterogeneous model developed by Berod et al [Int J Numer Method Biomed Eng 38, 2021] for representing the hemodynamic effects of endovascular prostheses is applied to a series of 10 patient specific cerebral aneurysms, 6 being treated by flow diverters, 4 being equipped with WEBs. Two markers correlated with the medical outcome of the treatment are used to assess the potential of the model, namely the saccular mean velocity and the inflow rate at the neck of the aneurysm. The comparison with the corresponding wire-resolved simulations is very favorable in both cases, and the model-based simulations also retrieve the jetting-type flows generated downstream of the struts. Noteworthy, the very same model was used for representing the flow diverters and the WEBs, showing the versatility and robustness of the heterogeneous modeling of the devices.

A heterogeneous model of endovascular devices for the treatment of intracranial aneurysms.

Numerical computations of hemodynamics inside intracranial aneurysms treated by endovascular braided devices such as flow-diverters contribute to understanding and improving such treatment procedures. Nevertheless, these simulations yield high computational and meshing costs due to the heterogeneity of length scales between the dense weave of the fine struts of the device and the arterial volume. Homogeneous strategies developed over the last decade to circumvent this issue substitute local dissipations due to the wires with a global effect in the form of a pressure-drop across the device surface. However, these methods cannot accurately reproduce the flow-patterns encountered near the struts, the latter strongly dictating the intra-saccular flow environment. In this work, a versatile theoretical framework which aims at correctly reproducing the local flow heterogeneities due to the wires while keeping memory consumption, meshing and computational times as low as possible is introduced. This model reproduces the drag forces exerted by the device struts onto the fluid, thus producing local and heterogeneous effects on the flow. Extensive validation for various flow and geometric configurations using an idealized device is performed. To further illustrate the method capabilities, a real patient-specific aneurysm endovascularly treated with a flow-diverter is used, enabling quantitative comparisons with classical approaches for both intra-saccular velocities and computational costs reduction. The proposed heterogeneous model endeavors to bridge the gap between computational fluid dynamics and clinical applications and ushers in a new era of numerical treatment planning with minimally costing computational tools.

Automated and objective removal of bifurcation aneurysms: Incremental improvements, and validation against healthy controls.

Abnormal hemodynamic stresses are thought to correlate with aneurysm initiation, growth, and rupture. We have previously investigated the role of wall shear stress (WSS) and WSS gradients (WSSG) in search for a mechanistic link to formation of sidewall aneurysms using an automated and objective tool for aneurysm removal and arterial reconstruction in combination with computational fluid dynamics (CFD). However, we warned against the use of the tool for bifurcation type aneurysms because of a potential unrealistic reconstruction of the apex. We hypothesized that inclusion of additional morphological features from the surrounding vasculature could overcome these constraints. We extended the previously published method for removal and reconstruction of the bifurcation vasculature based on diverging and converging points of the parent and daughter artery centerlines, to also include two new centerlines between the daughter vessels, one of them passed through the bifurcation center. Validation was performed by comparing the efficacy of the two algorithms, using ten healthy models of the internal carotid artery terminus as ground truth. Qualitative results showed that the bifurcation apexes became smoother relative to the original algorithm; more consistent with the reference models. This was reflected quantitatively by a reduced maximum distance between the reference and reconstructed surfaces, although not statistically significant. Furthermore, the modified algorithm also quantitatively improved CFD derived WSS and WSSG, especially the latter. In conclusion, the modified algorithm does not perfectly reconstruct the bifurcation apex, but provides an incremental improvement, especially important for the derived hemodynamic metrics of interest in vascular pathobiology.

Towards the Clinical utility of CFD for assessment of intracranial aneurysm rupture - a systematic review and novel parameter-ranking tool.

BACKGROUND: Intracranial aneurysms (IAs) are vascular dilations on cerebral vessels that affect between 1%-5% of the general population, and can cause life-threatening intracranial hemorrhage when ruptured. Computational fluid dynamics (CFD) has emerged as a promising tool to study IAs in recent years, particularly for rupture risk assessment. However, despite dozens of studies, CFD is still far from clinical use due to large variations and frequent contradictions in hemodynamic results between studies. PURPOSE: To identify key gaps in the field of CFD for the study of IA rupture, and to devise a novel tool to rank parameters based on potential clinical utility. METHODS: A Pubmed search identified 231 CFD studies for IAs. Forty-six studies fit our inclusion criteria, with a total of 2791 aneurysms. For included studies, study type, boundary conditions, solver resolutions, parameter definitions, geometric and hemodynamic parameters used, and results found were recorded. DATA SYNTHESIS: Aspect ratio, aneurysm size, low wall shear stress area, average wall shear stress, and size ratio were the parameters that correlate most strongly with IA rupture. LIMITATIONS: Significant differences in parameter definitions, solver spatial and temporal resolutions, number of cycles between studies as well as frequently missing information such as inlet flow rates were identified. A greater emphasis on prospective studies is also needed. CONCLUSIONS: Our recommendations will help increase standardization and bridge the gaps in the CFD community, and expedite the process of making CFD clinically useful in guiding the treatment of IAs.

Robust cerebrovascular blood velocity and flow rate estimation from 4D-CTA.

PURPOSE: Blood velocity and flow rate information may be helpful for a wide variety of applications, but it often requires separate acquisitions. The dynamic information combined with the high spatial resolution of four-dimensional computed tomography angiography (4D-CTA) offers the possibility to quantify blood flow simultaneous to vascular anatomy. METHODS: A 4D-CTA clinical protocol with a novel dedicated postprocessing were validated in vitro in a patient-specific model, and tested in a pilot study of six patients. Blood flow was assessed in both internal carotid (ICAs) and vertebral (VAs) arteries by analyzing spatial displacement of contrast agent in the form of time-intensity curves (TICs). Unlike previous approaches, it does not require any a priori assumptions about TIC shape, but rather computes mean velocity and flow rates from the spatial displacement of the TICs along the automatically segmented vessels. RESULTS: In vitro experiments showed good agreement between 4D-CTA and flowmeter measurements under steady and pulsatile flow conditions. In vivo measurements exhibited large interpatient variability of the TIC shapes, from which blood flow rates could nevertheless be successfully measured in all patients and investigated vessels. On average, measured flow rates were 3.2 ± 0.7 ml/s (in ICAs) and 1.3 ± 0.8 ml/s (in VAs) consistent with previous reference standards. Contrary to our novel approach, which considered the full TIC shape, application of previous time-to-peak analyses based on idealized TIC shapes showed limited reliability. CONCLUSIONS: We demonstrate the high potential of 4D-CTA for assessing blood velocity and flow rate in addition to anatomical evaluation. The wide variety of TIC shapes encountered in vivo highlights the importance of an adaptive TIC analysis as proposed in the present work.

On the quantification and visualization of transient periodic instabilities in pulsatile flows.

Turbulent-like flows without cycle-to-cycle variations are more frequently being reported in studies of cardiovascular flows. The associated stimuli might be of mechanobiological relevance, but how to quantify them objectively is not obvious. Classical Reynolds decomposition, where the flow is separated into mean and fluctuating velocity components, is not applicable as the phase-average is zero. We therefore expanded on established techniques and present the idea, analogous to Reynolds decomposition, to decompose a flow with transient instabilities into low- versus high frequency components, respectively, to discriminate flow instabilities from the underlying cardiac pulsatility. Transient wall shear stress and velocity signals derived from computational fluid dynamic simulations were transferred to the frequency domain. A high-pass filter was applied to subtract the 99% most-energy-containing frequencies, which gave a cut-off frequency of 25Hz. We introduce here the spectral power index, and compute the fluctuating kinetic energy, based on the high-pass filtered velocity components, both being frequency-based operators. The efficacy was evaluated in an aneurysm model for multiple flow rates demonstrating transition to turbulent-like flows. The frequency-based operators were found to better correlate with the qualitatively observed flow instabilities compared to conventional descriptors, like time-averaged wall shear stress or oscillatory shear index. We demonstrate how the high frequencies beyond the physiological range could be analyzed and/or transferred back to the time domain for quantification and visualization purposes. We have introduced general frequency-based operators, easily extendable to other cardiovascular territories based on a posteriori heuristic filtering that allows for separation, isolation, and quantification of cycle-invariant turbulent-like flows.

Intraventricular vector flow mapping-a Doppler-based regularized problem with automatic model selection.

We propose a regularized least-squares method for reconstructing 2D velocity vector fields within the left ventricular cavity from single-view color Doppler echocardiographic images. Vector flow mapping is formulated as a quadratic optimization problem based on an [Formula: see text]-norm minimization of a cost function composed of a Doppler data-fidelity term and a regularizer. The latter contains three physically interpretable expressions related to 2D mass conservation, Dirichlet boundary conditions, and smoothness. A finite difference discretization of the continuous problem was adopted in a polar coordinate system, leading to a sparse symmetric positive-definite system. The three regularization parameters were determined automatically by analyzing the L-hypersurface, a generalization of the L-curve. The performance of the proposed method was numerically evaluated using (1) a synthetic flow composed of a mixture of divergence-free and curl-free flow fields and (2) simulated flow data from a patient-specific CFD (computational fluid dynamics) model of a human left heart. The numerical evaluations showed that the vector flow fields reconstructed from the Doppler components were in good agreement with the original velocities, with a relative error less than 20%. It was also demonstrated that a perturbation of the domain contour has little effect on the rebuilt velocity fields. The capability of our intraventricular vector flow mapping (iVFM) algorithm was finally illustrated on in vivo echocardiographic color Doppler data acquired in patients. The vortex that forms during the rapid filling was clearly deciphered. This improved iVFM algorithm is expected to have a significant clinical impact in the assessment of diastolic function.