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Martin T, El Hage G, Chaalala C, Peeters JB, Bojanowski MW. Hemodynamic factors of spontaneous vertebral artery dissecting aneurysms assessed with numerical and deep learning algorithms: Role of blood pressure and asymmetry. Neurochirurgie 2024; 70:101519. [PMID: 38280371 DOI: 10.1016/j.neuchi.2023.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND OBJECTIVES The pathophysiology of spontaneous vertebral artery dissecting aneurysms (SVADA) is poorly understood. Our goal is to investigate the hemodynamic factors contributing to their formation using computational fluid dynamics (CFD) and deep learning algorithms. METHODS We have developed software that can use patient imagery as input to recreate the vertebrobasilar arterial system, both with and without SVADA, which we used in a series of three patients. To obtain the kinematic blood flow data before and after the aneurysm forms, we utilized numerical methods to solve the complex Navier-Stokes partial differential equations. This was accomplished through the application of a finite volume solver (OpenFoam/Helyx OS). Additionally, we trained a neural ordinary differential equation (NODE) to learn and replicate the dynamical streamlines obtained from the computational fluid dynamics (CFD) simulations. RESULTS In all three cases, we observed that the equilibrium of blood pressure distributions across the VAs, at a specific vertical level, accurately predicted the future SVADA location. In the two cases where there was a dominant VA, the dissection occurred on the dominant artery where blood pressure was lower compared to the contralateral side. The SVADA sac was characterized by reduced wall shear stress (WSS) and decreased velocity magnitude related to increased turbulence. The presence of a high WSS gradient at the boundary of the SVADA may explain its extension. Streamlines generated by CFD were learned with a neural ordinary differential equation (NODE) capable of capturing the system's dynamics to output meaningful predictions of the flow vector field upon aneurysm formation. CONCLUSION In our series, asymmetry in the vertebrobasilar blood pressure distributions at and proximal to the site of the future SVADA accurately predicted its location in all patients. Deep learning algorithms can be trained to model blood flow patterns within biological systems, offering an alternative to the computationally intensive CFD. This technology has the potential to find practical applications in clinical settings.
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Affiliation(s)
- Tristan Martin
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center 1000, rue St-Denis Montréal, QC H2X 0C, Canada
| | - Gilles El Hage
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center 1000, rue St-Denis Montréal, QC H2X 0C, Canada
| | - Chiraz Chaalala
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center 1000, rue St-Denis Montréal, QC H2X 0C, Canada
| | - Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center 1000, rue St-Denis Montréal, QC H2X 0C, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center 1000, rue St-Denis Montréal, QC H2X 0C, Canada.
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Owashi KP, Capel C, Balédent O. Cerebral arterial flow dynamics during systole and diastole phases in young and older healthy adults. Fluids Barriers CNS 2023; 20:65. [PMID: 37705096 PMCID: PMC10500860 DOI: 10.1186/s12987-023-00467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Since arterial flow is the leading actor in neuro-fluids flow dynamics, it might be interesting to assess whether it is meaningful to study the arterial flow waveform in more detail and whether this provides new important information. Few studies have focused on determining the influence of heart rate variation over time on the arterial flow curve. Therefore, this study aimed to evaluate cerebral arterial flow waveforms at extracranial and intracranial compartments in young and elderly healthy adults, also considering systole and diastole phases. METHODS Cine phase-contrast magnetic resonance imaging (CINE-PC MRI) was performed on twenty-eight healthy young volunteers (HYV) and twenty healthy elderly volunteers (HEV) to measure arterial blood flows at the extracranial and intracranial planes. A semi-automated protocol using MATLAB scripts was implemented to identify the main representative points in the arterial flow waveforms. Representative arterial profiles were estimated for each group. Moreover, the effects of age and sex on flow times, amplitude-related parameters, and parameters related to systole and diastole phases were evaluated at the extracranial and intracranial compartments. Student's t-test or Wilcoxon's test (depending on the normality of the distribution) was used to detect significant differences. RESULTS In HYVs, significant differences were observed between extracranial and intracranial levels in parameters related to the AP1 amplitude. Besides the detected differences in pulsatility index (extracranial: 0.92 ± 0.20 vs. 1.28 ± 0.33; intracranial: 0.79 ± 0.15 vs. 1.14 ± 0.18, p < .001) and average flow (715 ± 136 vs. 607 ± 125 ml/min, p = .008) between HYV and HEV, differences in the amplitude value of the arterial flow profile feature points were also noted. Contrary to systole duration (HYV: 360 ± 29 ms; HEV: 364 ± 47 ms), diastole duration presented higher inter-individual variability in both populations (HYV: 472 ± 145 ms; HEV: 456 ± 106 ms). Our results also showed that, with age, it is mainly the diastolic phase that changes. Although no significant differences in duration were observed between the two populations, the mean flow value in the diastolic phase was significantly lower in HEV (extracranial: 628 ± 128 vs. 457 ± 111 ml/min; intracranial: 599 ± 121 vs. 473 ± 100 ml/min, p < .001). No significant differences were observed in the arterial flow parameters evaluated between females and males in either HYV or HEV. CONCLUSION Our study provides a novel contribution on the influence of the cardiac cycle phases on cerebral arterial flow. The main contribution in this study concerns the identification of age-related alterations in cerebral blood flow, which occur mainly during the diastolic phase. Specifically, we observed that mean flow significantly decreases with age during diastole, whereas mean flow during systole is consistent.
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Affiliation(s)
| | - Cyrille Capel
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens, France
- Neurosurgery Department, Amiens Picardy University Medical Center, Amiens, France
| | - Olivier Balédent
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens, France
- Medical Image Processing Department, Amiens Picardy University Medical Center, Amiens, France
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Lotti F, Frizza F, Balercia G, Barbonetti A, Behre HM, Calogero AE, Cremers JF, Francavilla F, Isidori AM, Kliesch S, La Vignera S, Lenzi A, Marcou M, Pilatz A, Poolamets O, Punab M, Godoy MFP, Quintian C, Rajmil O, Salvio G, Shaeer O, Weidner W, Maseroli E, Cipriani S, Baldi E, Degl'Innocenti S, Danza G, Caldini AL, Terreni A, Boni L, Krausz C, Maggi M. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Prostate-vesicular transrectal ultrasound reference ranges and associations with clinical, seminal and biochemical characteristics. Andrology 2022; 10:1150-1171. [PMID: 35735741 PMCID: PMC9544532 DOI: 10.1111/andr.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/01/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
Background Transrectal ultrasound (TRUS) parameters are not standardized, especially in men of reproductive age. Hence, the European Academy of Andrology (EAA) promoted a multicenter study to assess the TRUS characteristics of healthy‐fertile men (HFM) to establish normative parameters. Objectives To report and discuss the prostate and seminal vesicles (SV) reference ranges and characteristics in HFM and their associations with clinical, seminal, biochemical parameters. Methods 188 men (35.6 ± 6.0 years) from a cohort of 248 HFM were studied, evaluating, on the same day, clinical, biochemical, seminal, TRUS parameters following Standard Operating Procedures. Results TRUS reference ranges and characteristics of the prostate and SV of HFM are reported herein. The mean PV was ∼25 ml. PV lower and upper limits were 15 and 35 ml, defining prostate hypotrophy and enlargement, respectively. PV was positively associated with age, waistline, current smoking (but not with T levels), seminal volume (and negatively with seminal pH), prostate inhomogeneity, macrocalcifications, calcification size and prostate arterial parameters, SV volume before and after ejaculation, deferential and epididymal size. Prostate calcifications and inhomogeneity were frequent, while midline prostatic cysts were rare and small. Ejaculatory duct abnormalities were absent. Periprostatic venous plexus size was positively associated with prostate calcifications, SV volume and arterial peak systolic velocity. Lower and upper limits of SV anterior‐posterior diameter after ejaculation were 6 and 16 mm, defining SV hypotrophy or dilation, respectively. SV total volume before ejaculation and delta SV total volume (DSTV) positively correlated with ejaculate volume, and DSTV correlated positively with sperm progressive motility. SV total volume after ejaculation was associated negatively with SV ejection fraction and positively with distal ampullas size. SV US abnormalities were rare. No association between TRUS and time to pregnancy, number of children or history of miscarriage was observed. Conclusions The present findings will help in better understanding male infertility pathophysiology and the meaning of specific TRUS findings.
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Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Frizza
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giancarlo Balercia
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Jann-Frederik Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - Felice Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marios Marcou
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Olev Poolamets
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - Margus Punab
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | | | - Claudia Quintian
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Osvaldo Rajmil
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gianmaria Salvio
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Elisa Maseroli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sarah Cipriani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Elisabetta Baldi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Selene Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giovanna Danza
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | | | - Luca Boni
- Clinical Trials Coordinating Center, Toscano Cancer Institute, University Hospital Careggi, Florence, Italy
| | - Csilla Krausz
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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van Tuijl RJ, Ruigrok YM, Velthuis BK, van der Schaaf IC, Rinkel GJE, Zwanenburg JJM. Velocity Pulsatility and Arterial Distensibility Along the Internal Carotid Artery. J Am Heart Assoc 2020; 9:e016883. [PMID: 32783485 PMCID: PMC7660833 DOI: 10.1161/jaha.120.016883] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Attenuation of velocity pulsatility along the internal carotid artery (ICA) is deemed necessary to protect the microvasculature of the brain. The role of the carotid siphon within the whole ICA trajectory in pulsatility attenuation is still poorly understood. This study aims to assess arterial variances in velocity pulsatility and distensibility over the whole ICA trajectory, including effects of age and sex. Methods and Results We assessed arterial velocity pulsatility and distensibility using flow-sensitized 2-dimensional phase-contrast 3.0 Tesla magnetic resonance imaging in 118 healthy participants. Velocity pulsatility index (vPI=(Vmax-Vmin)/Vmean) and arterial distensibility defined as area pulsatility index (Amax-Amin)/Amean) were calculated at C1, C3, and C7 segments of the ICA. vPI increased between C1 and C3 (0.85±0.13 versus 0.93±0.13, P<0.001 for averaged right+left ICA) and decreased between C3 and C7 (0.93±0.13 versus 0.84±0.13, P<0.001) with overall no effect (C1-C7). Conversely, the area pulsatility index decreased between C1 and C3 (0.18±0.06 versus 0.14±0.04, P<0.001) and increased between C3 and C7 (0.14±0.04 versus 0.31±0.09, P<0.001). vPI in men is higher than in women and increases with age (P<0.015). vPI over the carotid siphon declined with age but remained stable over the whole ICA trajectory. Conclusions Along the whole ICA trajectory, vPI increased from extracranial C1 up to the carotid siphon C3 with overall no effect on vPI between extracranial C1 and intracranial C7 segments. This suggests that the bony carotid canal locally limits the arterial distensibility of the ICA, increasing the vPI at C3 which is consequently decreased again over the carotid siphon. In addition, vPI in men is higher and increases with age.
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Affiliation(s)
- Rick J van Tuijl
- Department of Radiology University Medical Center Utrecht Utrecht The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery Rudolf Magnus Institute of Neuroscience University Medical Center Utrecht Utrecht The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology University Medical Center Utrecht Utrecht The Netherlands
| | | | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery Rudolf Magnus Institute of Neuroscience University Medical Center Utrecht Utrecht The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology University Medical Center Utrecht Utrecht The Netherlands
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