Laser Doppler velocimetry (LDV) and 3D phase-contrast magnetic resonance angiography (PC-MRA) velocity measurements: validation in an anatomically accurate cerebral artery aneurysm model with steady flow

Rupture-Risk Stratifying Patients with Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements

Arteriovenous malformations (AVMs) are high-pressure, low-resistance arterial-venous shunts without intervening capillaries. Up to 60% of AVMs present with an intracranial hemorrhage; however, noninvasive neuroimaging has increasingly diagnosed incidental AVMs. AVM management depends on weighing the lifetime rupture risk against the risks of intervention. Although AVM rupture risk relies primarily on angioarchitectural features, measuring hemodynamic flow is gaining traction. Accurate understanding of AVM hemodynamic flow parameters will help endovascular neurosurgeons and interventional neuroradiologists stratify patients by rupture risk and select treatment plans. This review examines various neuroimaging modalities and their capabilities to quantify AVM flow, as well as the relationship between AVM flow and rupture risk. Quantitative hemodynamic studies on the relationship between AVM flow and rupture risk have not reached a clear consensus; however, the preponderance of data suggests that higher arterial inflow and lower venous outflow in the AVM nidus contribute to increased hemorrhagic risk. Future studies should consider using larger sample sizes and standardized definitions of hemodynamic parameters to reach a consensus. In the meantime, classic angioarchitectural features may be more strongly correlated with AVM rupture than the amount of blood flow.

Hemodynamic changes during the obliteration process for cerebral arteriovenous malformations after radiosurgery

OBJECTIVE

The process of cerebral arteriovenous malformation (AVM) obliteration following radiosurgery is poorly understood. Authors of this retrospective study aimed to assess the changes in AVM hemodynamics after stereotactic radiosurgery (SRS) by using 3D flow magnetic resonance imaging (MRI) to elucidate the process of AVM obliteration.

METHODS

Twenty-four patients with AVMs treated with SRS between July 2015 and December 2017 were included in this study and classified into two groups depending on the duration of AVM obliteration: group A, obliteration within 3 years (n = 15); and group B, obliteration taking more than 3 years or no obliteration (n = 9). Blood flow (ml/min) in the largest feeding artery was measured before and after SRS by using time-averaged 3D flow MRI. The decreasing rate of blood flow in the feeding artery after SRS was calculated as the percent change from baseline blood flow. A Wilcoxon rank-sum test was used to compare the decreasing blood flow rate between the two groups at 4 and 12 months after SRS.

RESULTS

For the entire cohort, the mean decrease in blood flow in the feeding artery from baseline was 29% at 4 months and 71% at 12 months after SRS. In general, blood flow after SRS decreased faster in group A and slower in group B. The decreasing rates in blood flow at 4 and 12 months after SRS were significantly different between the two groups (p = 0.02 and < 0.001, respectively).

CONCLUSIONS

Tracking changes in AVM hemodynamics after SRS may be useful for assessing the progress of AVM obliteration and the therapeutic effects of SRS, possibly contributing to the prediction of subsequent obliteration outcome.

Alterations in plantar vessel blood flow in patients with mild diabetic peripheral neuropathy

INTRODUCTION

Early identification and treatment of diabetic peripheral neuropathy (DPN) are crucial. Presently, the mechanism of DPN is not very clear, and there are inconclusive conclusions about the influencing factors of vascular dynamic characteristics in DPN. This study aims to detect and compare the hemodynamic characteristics of plantar blood vessels in patients with mild DPN and healthy participants to explore a simple and reliable new idea and a potential method for early assessment of DPN and to investigate the influence of gender and age on hemodynamic characteristics.

RESEARCH DESIGN AND METHODS

Sixty age-matched and gender-matched patients with mild DPN (30 men and 30 women) and 60 healthy participants were randomly recruited. Color Doppler ultrasound was used to measure and analyze the hemodynamic characteristics of plantar-related vessels.

RESULTS

Ultrasonic measurements had good test-retest reliability. There may be no statistically significant differences in the blood flow velocity and blood flow in the plantar-related blood vessels of participants, irrespective of their gender and age. For patients with mild DPN, color Doppler ultrasound may indicate early hemodynamic abnormalities when there are no obvious abnormalities in the large arteries of the lower limbs, which are specifically manifested as increased blood flow velocity and blood flow in the distal small vessels.

CONCLUSIONS

Our study provides in vivo data support for the dynamic characteristics of the plantar blood vessel biomechanical model and provides a new idea of in vivo and non-invasive early diagnosis of DPN.

Impact of turbulence-induced asymmetric propagators on the accuracy of phase-contrast velocimetry

Phase-contrast magnetic resonance velocimetry (PC-MRI) has been widely used to investigate flow properties in numerous systems. In a horizontal cylindrical pipe (3 mm diameter), we investigated the accuracy of PC-MRI as the flow transitioned from laminar to turbulent flow (Reynolds number 352-2708). We focus primarily on velocimetry errors introduced by skewed intra-voxel displacement distributions, a consequence of PC-MRI theory assuming symmetric distributions. We demonstrated how rapid fluctuations in the velocity field, can produce broad asymmetric intravoxel displacement distributions near the wall. Depending on the shape of the distribution, this resulted in PC-MRI measurements under-estimating (positive skewness) or over-estimating (negative skewness) the true mean intravoxel velocity, which could have particular importance to clinical wall shear stress measurements. The magnitude of these velocity errors was shown to increase with the variance and decrease with the kurtosis of the intravoxel displacement distribution. These experimental results confirm our previous theoretical analysis, which gives a relationship for PC-MRI velocimetry errors, as a function of the higher moments of the intravoxel displacement distribution (skewness, variance, and kurtosis) and the experimental parameters q and Δ. This suggests that PC-MRI errors in such unsteady/turbulent flow conditions can potentially be reduced by employing lower q values or shorter observation times Δ.

Possible Association Between Rupture and Intranidal Microhemodynamics in Arteriovenous Malformations: Phase-Contrast Magnetic Resonance Angiography-Based Flow Quantification

OBJECTIVE

To examine a potential association between intranidal microhemodynamics and rupture using a phase-contrast magnetic resonance angiography (PCMRA)-based flow quantification technique in arteriovenous malformations (AVMs).

METHODS

We retrospectively collected data on 30 consecutive patients with AVMs (23 unruptured and 7 ruptured). Based on PCMRA data, maximal (V_max) and mean (V_mean) intranidal velocities were calculated. Logistic regression analysis was performed to assess factors associated with previous AVM rupture.

RESULTS

All ruptures occurred within 6 months before PCMRA. The mean nidus volume was 4.7 mL. Eleven patients (37%) had deep draining vein(s), and 6 patients (20%) had a deep-seated nidus. The mean ± standard deviation V_mean and V_max were 9.6 ± 2.8 cm/second and 66.7 ± 26.2 cm/second, respectively. The logistic regression analyses revealed that higher V_max (P = 0.075, unit odds ratio [OR] = 1.05, 95% confidence interval [95% CI] = 1.00-1.10) was significantly associated with prior hemorrhage. The receiver-operating curve analyses demonstrated that a V_mean of 10.8 cm/second (area under the curve = 0.671) and V_max of 90.2 cm/second (area under the curve = 0.764) maximized the Youden Index. A V_max > 90 cm/second was significantly associated with AVM rupture both in the univariate (P = 0.025, OR = 9.0, 95% CI = 1.3-61.1) and multivariate (P = 0.008, OR = 51.7, 95% CI = 2.8-968.3) analyses.

CONCLUSIONS

Presence of faster velocities in intranidal vessels may suggest aberrant microhemodynamics and thus be associated with AVM rupture. PCMRA-based velocimetry seems to be a promising tool to predict future AVM rupture.

A Transparent Vessel-on-a-Chip Device for Hemodynamic Analysis and Early Diagnosis of Intracranial Aneurysms by CFD and PC-MRI

Hemodynamics plays a critical role in early diagnosis and investigating the growth mechanism of intracranial aneurysms (IAs), which usually induce hemorrhagic stroke, serious neurological diseases, and even death. We developed a transparent blood vessel-on-a-chip (VOC) device for magnetic resonance imaging (MRI) to provide characteristic flow fields of early IAs as the reference for early diagnosis. This VOC device takes advantage of the transparent property to clearly exhibit the internal structure and identify the needless air bubbles in the biomimetic fluid experiment, which significantly affects the MRI image quality. Furthermore, the device was miniaturized and easily assembled with arbitrary direction using a 3D-printed scaffold in a radiofrequency coil. Computational fluid dynamics (CFD) simulations of the flow field were greatly consistent with those data from MRI. Both internal flow and wall shear stress (WSS) exhibited very low levels during the IA growth, thus leading to the growth and rupture of IAs. PC-MRI images can also provide a reasonable basis for the early diagnosis of IAs. Therefore, we believed that this proposed VOC-based MR imaging technique has great potential for early diagnostic of intracranial aneurysms.

Micro-indentation and optical coherence tomography for the mechanical characterization of embryos: Experimental setup and measurements on chicken embryos

The investigation of the mechanical properties of embryos is expected to provide valuable information on the phenomenology of morphogenesis. It is thus believed that, by mapping the viscoelastic features of an embryo at different stages of growth, it may be possible to shed light on the role of mechanics in embryonic development. To contribute to this field, we present a new instrument that can determine spatiotemporal distributions of mechanical properties of embryos over a wide area and with unprecedented accuracy. The method relies on combining ferrule-top micro-indentation, which provides local measurements of viscoelasticity, with Optical Coherence Tomography, which can reveal changes in tissue morphology and help the user identify the indentation point. To prove the working principle, we have collected viscoelasticity maps of fixed and live HH11-HH12 chicken embryos. Our study shows that the instrument can reveal correlations between tissue morphology and mechanical behavior. STATEMENT OF SIGNIFICANCE: Local mechanical properties of soft biological tissue play a crucial role in several biological processes, including cell differentiation, cell migration, and body formation; therefore, measuring tissue properties at high resolution is of great interest in biology and tissue engineering. To provide an efficient method for the biomechanical characterization of soft biological tissues, we introduce a new tool in which the combination of non-invasive Optical Coherence Tomography imaging and depth-controlled indentation measurements allows one to map the viscoelastic properties of biological tissue and investigate correlations between local mechanical features and tissue morphology with unprecedented resolution.

Accuracy of phase-contrast velocimetry in systems with skewed intravoxel velocity distributions

Phase contrast velocimetry (PCV) has been widely used to investigate flow properties in numerous systems. Several authors have reported errors in velocity measurements and have speculated on the sources, which have ranged from eddy current effects to acceleration artefacts. An often overlooked assumption in the theory of PCV, which may not be met in complex or unsteady flows, is that the intravoxel displacement distributions (propagators) are symmetric. Here, the effect of the higher moments of the displacement distribution (variance, skewness and kurtosis) on the accuracy of PCV is investigated experimentally and theoretically. Phase and propagator measurements are performed on tailored intravoxel distributions, achieved using a simple phantom combined with a single large voxel. Asymmetric distributions (Skewness ≠ 0) are shown to generate important phase measurement errors that lead to significant velocimetry errors. Simulations of the phase of the spin vector sum, based on experimentally measured propagators, are shown to quantitatively reproduce the relationship between measured phase and experimental parameters. These allow relating the observed velocimetry errors to a discrepancy between the average phase of intravoxel spins considered in PCV theory and the vector phase actually measured by a PFG experiment. A theoretical expression is derived for PCV velocimetry errors as a function of the moments of the displacement distribution. Positively skewed distributions result in an underestimation of the true mean velocity, while negatively skewed distributions result in an overestimation. The magnitude of these errors is shown to increase with the variance and decrease with the kurtosis of the intravoxel displacement distribution.

In-vitro validation of 4D flow MRI measurements with an experimental pulsatile flow model

PURPOSE

The purpose of this study was to assess the precision of four-dimensional (4D) phase-contrast magnetic resonance imaging (PCMRI) to measure mean flow and peak velocity (V_max) in a pulsatile flow phantom and to test its sensitivity to spatial resolution and Venc.

MATERIAL AND METHODS

The pulsatile flow phantom consisted of a straight tube connected to the systemic circulation of an experimental mock circulatory system. Four-dimensional-PCMR images were acquired using different spatial resolutions (minimum pixel size: 1.5×1.5×1.5mm³) and velocity encoding sensitivities (up to three times V_max). Mean flow and V_max calculated from 4D-PCMRI were compared respectively to the reference phantom flow parameters and to V_max obtained from two-dimensional (2D)-PCMRI.

RESULTS

4D-PCI measured mean flow with a precision of -0.04% to+5.46%, but slightly underestimated V_max when compared to 2D-PCMRI (differences ranging from -1.71% to -3.85%). 4D PCMRI mean flow measurement was influenced by spatial resolution (P<0.001) with better results obtained with smaller voxel size. There was no effect of Venc on mean flow measurement. Regarding V_max, neither spatial resolution nor Venc did influence the precision of the measurement.

CONCLUSION

Using an experimental pulsatile flow model 4D-PCMRI is accurate to measure mean flow and V_max with better results obtained with higher spatial resolution. We also show that Venc up to 3 times higher than V_max may be used with no effect on these measurements.

Emerging Applications of Abdominal 4D Flow MRI

OBJECTIVE

Comprehensive assessment of abdominal hemodynamics is crucial for many clinical diagnoses but is challenged by a tremendous complexity of anatomy, normal physiology, and a wide variety of pathologic abnormalities. This article introduces 4D flow MRI as a powerful technique for noninvasive assessment of the hemodynamics of abdominal vascular territories.

CONCLUSION

Four-dimensional flow MRI provides clinicians with a more extensive and straightforward approach to evaluate disorders that affect blood flow in the abdomen. This review presents a series of clinical cases to illustrate the utility of 4D flow MRI in the comprehensive assessment of the abdominal circulation.

[Quantitative Analysis of Wall Shear Stress for Human Carotid Bifurcation at Cardiac Phases by the Use of Phase Contrast Cine Magnetic Resonance Imaging: Computational Fluid Dynamics Study]

PURPOSE

Detailed strategy for regional hemodynamics is significant for knowledge of plaque development on vascular diseases such as atherosclerosis. The aim of this study was to derive relation between atherosclerosis and hemodynamics at human carotid bifurcation by the use of computational fluid dynamics (CFD), and to provide more accurate hemodynamic information.

METHODS

Blood velocity datasets at common carotid artery were obtained by phase-contrast cine magnetic resonance imaging (PC cine MRI). Carotid bifurcation model was computed for systolic, mid-diastolic, and end-diastolic phase. Comparison of wall shear stress (WSS) was performed for each cardiac phase.

RESULTS

PC cine MRI provided velocity measurement for common carotid artery with various cardiac phases. The blood velocity had acute variation from 0.21 m/s to 1.07 m/s at systolic phase. The variation of WSS during cardiac phase was presented at carotid bifurcation model. High shear stress area was observed at dividing wall for all cardiac phases. The systole-diastole WSS ratio was 10.15 at internal carotid side of bifurcation. And low shear stress (<0.5 Pa) was observed at internal carotid side of bifurcation.

CONCLUSION

Bifurcation area represented low shear stress and changed significantly WSS. The specific area with significant change in shear stress and low shear stress had good agreement with predilection sites of atherosclerosis. The result suggested that hemodynamics was related to atherosclerosis, and CFD analysis with various cardiac phases that were provided by PC cine MRI was allowed to determine an accurate analysis condition. This led to the representation of hemodynamics in vivo.

Basic Endovascular Skills Trainer: A surgical simulator for the training of novice practitioners of endovascular procedures

In recent years the clinical interest for structured training in endovascular procedures has increased. Such procedures respect the physical integrity of the patient and at the same time ensure good therapeutic results. This study describes the development and testing of the B.E.S.T. (Basic Endovascular Skills Trainer) simulator. The B.E.S.T is an innovative physical endovascular simulator to learn basic skills of endovascular surgery. The simulator was tested by 25 clinicians with different levels of experience: novices, intermediates, and experts. All clinicians agree on affirming the importance of training in endovascular surgery; in particular they consider the B.E.S.T a valid simulator to learn specific basic skills of vascular surgery.

Comparing velocity and fluid shear stress in a stenotic phantom with steady flow: phase-contrast MRI, particle image velocimetry and computational fluid dynamics

OBJECT

This study aims to validate phase-contrast magnetic resonance imaging (PC-MRI) measurements of a steady flow through a severe stenotic phantom using particle image velocimetry (PIV) and computational fluid dynamics (CFD).

MATERIALS AND METHODS

The study was performed in an axisymmetric 87 % area stenosis model using an inlet Reynolds number (Re) of 160, corresponding to a jet Re of 444. Velocity patterns and estimated fluid shear stresses from three modalities were analyzed and compared qualitatively and quantitatively.

RESULTS

Visual analysis via contour subtraction and Bland-Altman plots showed good agreement for flow velocities and less agreement for maximum shear stress (MSS). The Pearson's coefficients of correlation between PC-MRI and PIV were 0.97 for the velocity field and 0.82 for the MSS. The corresponding parameters between PC-MRI and CFD were 0.96 and 0.84, respectively.

CONCLUSION

Findings indicate that PC-MRI can be implemented to estimate velocity flow fields and MSS; however, this method is not sufficiently accurate to quantify the MSS at regions of high shear rate.

In vitro validation of flow measurement with phase contrast MRI at 3 tesla using stereoscopic particle image velocimetry and stereoscopic particle image velocimetry-based computational fluid dynamics

PURPOSE

To validate conventional phase-contrast MRI (PC-MRI) measurements of steady and pulsatile flows through stenotic phantoms with various degrees of narrowing at Reynolds numbers mimicking flows in the human iliac artery using stereoscopic particle image velocimetry (SPIV) as gold standard.

MATERIALS AND METHODS

A series of detailed experiments are reported for validation of MR measurements of steady and pulsatile flows with SPIV and CFD on three different stenotic models with 50%, 74%, and 87% area occlusions at three sites: two diameters proximal to the stenosis, at the throat, and two diameters distal to the stenosis.

RESULTS

Agreement between conventional spin-warp PC-MRI with Cartesian read-out and SPIV was demonstrated for both steady and pulsatile flows with mean Reynolds numbers of 130, 160, and 190 at the inlet by evaluating the linear regression between the two methods. The analysis revealed a correlation coefficient of > 0.99 and > 0.96 for steady and pulsatile flows, respectively. Additionally, it was found that the most accurate measures of flow by the sequence were at the throat of the stenosis (error < 5% for both steady and pulsatile mean flows). The flow rate error distal to the stenosis was primarily found to be a function of narrowing severity including dependence on proper Venc selection.

CONCLUSION

SPIV and CFD provide excellent approaches to in vitro validation of new or existing PC-MRI flow measurement techniques.

Repeatability and internal consistency of abdominal 2D and 4D phase contrast MR flow measurements

RATIONALE AND OBJECTIVES

The aim of this study was to assess the repeatability and internal consistency of flow measurements in the renal arteries and pararenal aorta with the use of standard two-dimensional (2D) and novel four-dimensional (4D) phase contrast (PC) magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Ten healthy volunteers were imaged with a radially undersampled 4D PC technique centered over the renal arteries and with four 2D PC slices placed in the supra/infrarenal aorta and the left/right renal arteries; this MRI exam was performed twice on each subject. Flow measurements in all four vessels were computed from 2D and 4D PC data sets. Student's t-tests (P < .05) were used to assess differences between in-flow (suprarenal aorta) and out-flow (infrarenal aorta + left renal artery + right renal artery) for the 2D and 4D techniques, to compare in- and out-flow, and to compare repeated measurements of 2D and 4D flow measurements.

RESULTS

No significant differences were found in repeated measurements of 2D (P = .15) or 4D (P = .39) data. No significant difference was found between 2D (3.4 ± 2.8 mL/cardiac cycle) and 4D (3.5 ± 2.7 mL/cardiac cycle) in- and out-flow differences (P = .88). Out-flow was greater than in-flow for 2D measurements (P = .003); no difference was found for 4D measurements.

CONCLUSION

The 2D and 4D techniques demonstrated strong repeatability and internal consistency of flow measurements in the renal arteries and pararenal aorta.

Experimental validation of numerical simulations on a cerebral aneurysm phantom model

The treatment of cerebral aneurysms, found in roughly 5% of the population and associated in case of rupture to a high mortality rate, is a major challenge for neurosurgery and neuroradiology due to the complexity of the intervention and to the resulting, high hazard ratio. Improvements are possible but require a better understanding of the associated, unsteady blood flow patterns in complex 3D geometries. It would be very useful to carry out such studies using suitable numerical models, if it is proven that they reproduce accurately enough the real conditions. This validation step is classically based on comparisons with measured data. Since in vivo measurements are extremely difficult and therefore of limited accuracy, complementary model-based investigations considering realistic configurations are essential. In the present study, simulations based on computational fluid dynamics (CFD) have been compared with in situ, laser-Doppler velocimetry (LDV) measurements in the phantom model of a cerebral aneurysm. The employed 1:1 model is made from transparent silicone. A liquid mixture composed of water, glycerin, xanthan gum and sodium chloride has been specifically adapted for the present investigation. It shows physical flow properties similar to real blood and leads to a refraction index perfectly matched to that of the silicone model, allowing accurate optical measurements of the flow velocity. For both experiments and simulations, complex pulsatile flow waveforms and flow rates were accounted for. This finally allows a direct, quantitative comparison between measurements and simulations. In this manner, the accuracy of the employed computational model can be checked.

Distinctive flow pattern of wall shear stress and oscillatory shear index: similarity and dissimilarity in ruptured and unruptured cerebral aneurysm blebs

Object

The difference in the hemodynamics of wall shear stress (WSS) and oscillatory shear index (OSI) between ruptured and unruptured aneurysms is not well understood. The authors investigated the hemodynamic similarities and dissimilarities in ruptured and thin-walled unruptured aneurysm blebs.

Methods

Magnetic resonance imaging–based fluid dynamics analysis was used to calculate WSS and OSI, and hemodynamic and intraoperative findings were compared. The authors also compared ruptured and unruptured thin-walled blebs for the magnitude of WSS and OSI.

Results

Intraoperatively, 13 ruptured and 139 thin-walled unruptured aneurysm blebs were identified. Twelve of the ruptured (92.3%) and 124 of the unruptured blebs (89.2%) manifested low WSS and high OSI. The degree of WSS was significantly lower in ruptured (0.49 ± 0.12 Pa) than in unruptured (0.64 ± 0.15 Pa; p < 0.01) blebs.

Conclusions

Ruptured and unruptured blebs shared a distinctive pattern of low WSS and high OSI. The degree of WSS at the rupture site was significantly lower than in the unruptured thin-walled blebs.

Complex flow patterns in a real-size intracranial aneurysm phantom: phase contrast MRI compared with particle image velocimetry and computational fluid dynamics

The aim of this study was to validate the flow patterns measured by high-resolution, time-resolved, three-dimensional phase contrast MRI in a real-size intracranial aneurysm phantom. Retrospectively gated three-dimensional phase contrast MRI was performed in an intracranial aneurysm phantom at a resolution of 0.2 × 0.2 × 0.3 mm(3) in a solenoid rat coil. Both steady and pulsatile flows were applied. The phase contrast MRI measurements were compared with particle image velocimetry measurements and computational fluid dynamics simulations. A quantitative comparison was performed by calculating the differences between the magnitude of the velocity vectors and angles between the velocity vectors in corresponding voxels. Qualitative analysis of the results was executed by visual inspection and comparison of the flow patterns. The root-mean-square errors of the velocity magnitude in the comparison between phase contrast MRI and computational fluid dynamics were 5% and 4% of the maximum phase contrast MRI velocity, and the medians of the angle distribution between corresponding velocity vectors were 16° and 14° for the steady and pulsatile measurements, respectively. In the phase contrast MRI and particle image velocimetry comparison, the root-mean-square errors were 12% and 10% of the maximum phase contrast MRI velocity, and the medians of the angle distribution between corresponding velocity vectors were 19° and 15° for the steady and pulsatile measurements, respectively. Good agreement was found in the qualitative comparison of flow patterns between the phase contrast MRI measurements and both particle image velocimetry measurements and computational fluid dynamics simulations. High-resolution, time-resolved, three-dimensional phase contrast MRI can accurately measure complex flow patterns in an intracranial aneurysm phantom.

The mechanics of development: Models and methods for tissue morphogenesis

Embryonic development is a physical process during which groups of cells are sculpted into functional organs. The mechanical properties of tissues and the forces exerted on them serve as epigenetic regulators of morphogenesis. Understanding these mechanobiological effects in the embryo requires new experimental approaches. Here we focus on branching of the lung airways and bending of the heart tube to describe examples of mechanical and physical cues that guide cell fate decisions and organogenesis. We highlight recent technological advances to measure tissue elasticity and endogenous mechanical stresses in real time during organ development. We also discuss recent progress in manipulating forces in intact embryos.

Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics

INTRODUCTION

Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to compare hemodynamics of intracranial aneurysms of MR fluid dynamics (MRFD) using 3D cine PC MR imaging (4D-Flow) at 1.5 T and MR-based computational fluid dynamics (CFD).

METHODS

4D-Flow was performed for five intracranial aneurysms by a 1.5 T MR scanner. 3D TOF MR angiography was performed for geometric information. The blood flow in the aneurysms was modeled using CFD simulation based on the finite element method. We used MR angiographic data as the vascular models and MR flow information as boundary conditions in CFD. 3D velocity vector fields, 3D streamlines, shearing velocity maps, wall shear stress (WSS) distribution maps and oscillatory shear index (OSI) distribution maps were obtained by MRFD and CFD and were compared.

RESULTS

There was a moderate to high degree of correlation in 3D velocity vector fields and a low to moderate degree of correlation in WSS of aneurysms between MRFD and CFD using regression analysis. The patterns of 3D streamlines were similar between MRFD and CFD. The small and rotating shearing velocities and higher OSI were observed at the top of the spiral flow in the aneurysms. The pattern and location of shearing velocity in MRFD and CFD were similar. The location of high oscillatory shear index obtained by MRFD was near to that obtained by CFD.

CONCLUSION

MRFD and CFD of intracranial aneurysms correlated fairly well.

Rest versus exercise hemodynamics for middle cerebral artery aneurysms: a computational study

BACKGROUND AND PURPOSE

Exercise is an accepted method of improving cardiovascular health; however, the impact of increases in blood flow and heart rate on a cerebral aneurysms is unknown. This study was performed to simulate the changes in hemodynamic conditions within an intracranial aneurysm when a patient exercises.

MATERIALS AND METHODS

Rotational 3D digital subtraction angiograms were used to reconstruct patient-specific geometries of 3 aneurysms located at the bifurcation of the middle cerebral artery. CFD was used to solve for transient flow fields during simulated rest and exercise conditions. Inlet conditions were set by using published transcranial Doppler sonography data for the middle cerebral artery. Velocity fields were analyzed and postprocessed to provide physiologically relevant metrics.

RESULTS

Overall flow patterns were not significantly altered during exercise. Across subjects, during the exercise simulation, time-averaged WSS increased by a mean of 20% (range, 4%-34%), the RRT of a particle in the near-wall flow decreased by a mean of 28% (range, 13%-40%), and time-averaged pressure on the aneurysm wall did not change significantly. In 2 of the aneurysms, there was a 3-fold order-of-magnitude spatial difference in RRT between the aneurysm and surrounding vasculature.

CONCLUSIONS

WSS did not increase significantly during simulated moderate aerobic exercise. While the reduction in RRT during exercise was small in comparison with spatial differences, there may be potential benefits associated with decreased RRT (ie, improved replenishment of nutrients to cells within the aneurysmal tissue).

Comparative velocity investigations in cerebral arteries and aneurysms: 3D phase-contrast MR angiography, laser Doppler velocimetry and computational fluid dynamics

In western populations, cerebral aneurysms develop in approximately 4% of humans and they involve the risk of rupture. Blood flow patterns are of interest for understanding the pathogenesis of the lesions and may eventually contribute to deciding on the most efficient treatment procedure for a specific patient. Velocity mapping with phase-contrast magnetic resonance angiography (PC-MRA) is a non-invasive method for performing in vivo measurements on blood velocity. Several hemodynamic properties can either be derived directly from these measurements or a flow field with all its parameters can be simulated on the basis of the measurements. For both approaches, the accuracy of the PC-MRA data and subsequent modeling must be validated. Therefore, a realistic transient flow field in a well-defined patient-specific silicone phantom was investigated. Velocity investigations with PC-MRA in a 3 Tesla MR scanner, laser Doppler velocimetry (LDV) and computational fluid dynamics (CFD) were performed in the same model under equal flow conditions and compared to each other. The results showed that PC-MRA was qualitatively similar to LDV and CFD, but showed notable quantitative differences, while LDV and CFD agreed well. The accuracy of velocity quantification by PC-MRA was best in straight artery regions with the measurement plane being perpendicular to the primary flow direction. The accuracy decreased in regions with disturbed flow and in cases where the measurement plane was not perpendicular to the primary flow. Due to these findings, it is appropriate to use PC-MRA as the inlet and outlet conditions for numerical simulations to calculate velocities and shear stresses in disturbed regions like aneurysms, rather than derive these values directly from the full PC-MRA measured velocity field.

Methodologies to assess blood flow in cerebral aneurysms: current state of research and perspectives

With intracranial aneurysms disease bringing a weakened arterial wall segment to initiate, grow and potentially rupture an aneurysm, current understanding of vessel wall biology perceives the disease to follow the path of a dynamic evolution and increasingly recognizes blood flow as being one of the main stakeholders driving the process. Although currently mostly morphological information is used to decide on whether or not to treat a yet unruptured aneurysm, among other factors, knowledge of blood flow parameters may provide an advanced understanding of the mechanisms leading to further aneurismal growth and potential rupture. Flow patterns, velocities, pressure and their derived quantifications, such as shear and vorticity, are today accessible by direct measurements or can be calculated through computation. This paper reviews and puts into perspective current experimental methodologies and numerical approaches available for such purposes. In our view, the combination of current medical imaging standards, numerical simulation methods and endovascular treatment methods allow for thinking that flow conditions govern more than any other factor fate and treatment in cerebral aneurysms. Approaching aneurysms from this perspective improves understanding, and while requiring a personalized aneurysm management by flow assessment and flow correction, if indicated.

Phase-contrast magnetic resonance imaging measurements in intracranial aneurysms in vivo of flow patterns, velocity fields, and wall shear stress: comparison with computational fluid dynamics

Evolution of intracranial aneurysms is known to be related to hemodynamic forces such as wall shear stress (WSS) and maximum shear stress (MSS). Estimation of these parameters can be performed using numerical simulations with computational fluid dynamics (CFD), but can also be directly measured with magnetic resonance imaging (MRI) using a time-dependent 3D phase-contrast sequence with encoding of each of the three components of the velocity vectors (7D-MRV). To study the accuracy of 7D-MRV in estimating these parameters in vivo, in comparison with CFD, 7D-MRV and patient-specific CFD modeling was performed for 3 patients who had intracranial aneurysms. Visual and quantitative analyses of the flow pattern and distribution of velocities, MSS, and WSS were performed using the two techniques. Spearman's coefficients of correlation between the two techniques were 0.56 for the velocity field, 0.48 for MSS, and 0.59 for WSS. Visual analysis and Bland-Altman plots showed good agreement for flow pattern and velocities but large discrepancies for MSS and WSS. These results indicate that 7D-MRV can be used in vivo to measure velocity flow fields and for estimating MSS and WSS. Currently, however, this method cannot accurately quantify the latter two parameters.

A fast alternative to computational fluid dynamics for high quality imaging of blood flow

Obtaining detailed, patient-specific blood flow information would be very useful in detecting and monitoring cardio-vascular diseases. Current approaches rely on computational fluid dynamics to achieve this; however, these are hardly usable in the daily clinical routine due to the required technical supervision and long computing times. We propose a fast measurement enhancement method that requires neither supervision nor long computation and it is the objective of this paper to evaluate its performance as compared to the state-of-the-art. To this end a large set of abdominal aortic bifurcation geometries was used to test this technique and the results were compared to measurements and numerical simulations. We find that this method is able to dramatically improve the quality of the measurement information, in particular the flow-derived quantities such as wall shear stress. Additionally, good estimation of unmeasurable quantities such as pressure can be provided. We demonstrate that this approach is a practical and clinically feasible alternative to fully-blown, time-consuming, patient-specific flow simulations.