Towards patient-specific cardiovascular modeling system using the immersed boundary technique

Continuum topological derivative - a novel application tool for denoising CT and MRI medical images

BACKGROUND

CT and MRI modalities are important diagnostics tools for exploring the anatomical and tissue properties, respectively of the human beings. Several advancements like HRCT, FLAIR and Propeller have advantages in diagnosing the diseases very accurately, but still have enough space for improvements due to the presence of inherent and instrument noises. In the case of CT and MRI, the quantum mottle and the Gaussian and Rayleigh noises, respectively are still present in their advanced modalities of imaging. This paper addresses the denoising problem with continuum topological derivative technique and proved its trustworthiness based on the comparative study with other traditional filtration methods such as spatial, adaptive, frequency and transformation techniques using measures like visual inspection and performance metrics.

METHODS

This research study focuses on identifying a novel method for denoising by testing different filters on HRCT (High-Resolution Computed Tomography) and MR (Magnetic Resonance) images. The images were acquired from the Image Art Radiological Scan Centre using the SOMATOM CT and SIGNA Explorer (operating at 1.5 Tesla) machines. To compare the performance of the proposed CTD (Continuum Topological Derivative) method, various filters were tested on both HRCT and MR images. The filters tested for comparison were Gaussian (2D convolution operator), Wiener (deconvolution operator), Laplacian and Laplacian diagonal (2nd order partial differential operator), Average, Minimum, and Median (ordinary spatial operators), PMAD (Anisotropic diffusion operator), Kuan (statistical operator), Frost (exponential convolution operator), and HAAR Wavelet (time-frequency operator). The purpose of the study was to evaluate the effectiveness of the CTD method in removing noise compared to the other filters. The performance metrics were analyzed to assess the diligence of noise removal achieved by the CTD method. The primary outcome of the study was the removal of quantum mottle noise in HRCT images, while the secondary outcome focused on removing Gaussian (foreground) and Rayleigh (background) noise in MR images. The study aimed to observe the dynamics of noise removal by examining the values of the performance metrics. In summary, this study aimed to assess the denoising ability of various filters in HRCT and MR images, with the CTD method being the proposed approach. The study evaluated the performance of each filter using specific metrics and compared the results to determine the effectiveness of the CTD method in removing noise from the images.

RESULTS

Based on the calculated performance metric values, it has been observed that the CTD method successfully removed quantum mottle noise in HRCT images and Gaussian as well as Rayleigh noise in MRI. This can be evidenced by the PSNR (Peak Signal-to-Noise Ratio) metric, which consistently exhibited values ranging from 50 to 65 for all the tested images. Additionally, the CTD method demonstrated remarkably low residual values, typically on the order of e-09, which is a distinctive characteristic across all the images. Furthermore, the performance metrics of the CTD method consistently outperformed those of the other tested methods. Consequently, the results of this study have significant implications for the quality, structural similarity, and contrast of HRCT and MR images, enabling clinicians to obtain finer details for diagnostic purposes.

CONCLUSION

Continuum topological derivative algorithm is found to be constructive in removing prominent noises in both CT and MRI images and can serve as a potential tool for recognition of anatomical details in case of diseased and normal ones. The results obtained from this research work are highly inspiring and offer great promise in obtaining accurate diagnostic information for critical cases such as Thoracic Cavity Carina, Brain SPI Globe Lens 4th Ventricle, Brain-Middle Cerebral Artery, Brain-Middle Cerebral Artery and neoplastic lesions. These findings lay the foundation for implementing the proposed CTD technique in routine clinical diagnosis.

Role of solution reconstruction in hypersonic viscous computations using a sharp interface immersed boundary method

This work discusses the development of a sharp interface immersed boundary (IB) method for viscous compressible flows and its assessment for accurate computations of wall shear and heat fluxes in hypersonic flows. The IB method is implemented in an unstructured Cartesian finite-volume (FV) framework and resolves the geometric interface sharply on the nonconformal mesh through direct imposition of boundary conditions employing a local reconstruction approach. The efficacy of the IB-FV solver is investigated for canonical high-speed viscous flows over a range of Mach numbers. The numerical results indicate that the surface pressure and shear stress distributions are computed with reasonable accuracy, whereas surface heat fluxes for aerodynamically blunt configurations are underpredicted. Employing a set of carefully designed experiments and simple diagnostic tools, we probe the possible causes for the underprediction in heat flux. We show that there exist two sources of error-one due to grid resolution and the other due to solution reconstruction, with the latter being more prominent and responsible for the observed underprediction in heat fluxes. Studies reveal that the heat flux estimates are sensitive to the choice of temperature reconstruction and linear interpolations could lead to poor estimates of heat flux. Our investigations conclusively point out the fact that existing polynomial-based reconstruction approaches for sharp interface IB techniques are not necessarily adequate for heat transfer predictions in high Reynolds number hypersonic flows.

A review on low-dimensional physics-based models of systemic arteries: application to estimation of central aortic pressure

The physiological processes and mechanisms of an arterial system are complex and subtle. Physics-based models have been proven to be a very useful tool to simulate actual physiological behavior of the arteries. The current physics-based models include high-dimensional models (2D and 3D models) and low-dimensional models (0D, 1D and tube-load models). High-dimensional models can describe the local hemodynamic information of arteries in detail. With regard to an exact model of the whole arterial system, a high-dimensional model is computationally impracticable since the complex geometry, viscosity or elastic properties and complex vectorial output need to be provided. For low-dimensional models, the structure, centerline and viscosity or elastic properties only need to be provided. Therefore, low-dimensional modeling with lower computational costs might be a more applicable approach to represent hemodynamic properties of the entire arterial system and these three types of low-dimensional models have been extensively used in the study of cardiovascular dynamics. In recent decades, application of physics-based models to estimate central aortic pressure has attracted increasing interest. However, to our best knowledge, there has been few review paper about reconstruction of central aortic pressure using these physics-based models. In this paper, three types of low-dimensional physical models (0D, 1D and tube-load models) of systemic arteries are reviewed, the application of three types of models on estimation of central aortic pressure is taken as an example to discuss their advantages and disadvantages, and the proper choice of models for specific researches and applications are advised.

Application of Patient-Specific Computational Fluid Dynamics in Coronary and Intra-Cardiac Flow Simulations: Challenges and Opportunities

The emergence of new cardiac diagnostics and therapeutics of the heart has given rise to the challenging field of virtual design and testing of technologies in a patient-specific environment. Given the recent advances in medical imaging, computational power and mathematical algorithms, patient-specific cardiac models can be produced from cardiac images faster, and more efficiently than ever before. The emergence of patient-specific computational fluid dynamics (CFD) has paved the way for the new field of computer-aided diagnostics. This article provides a review of CFD methods, challenges and opportunities in coronary and intra-cardiac flow simulations. It includes a review of market products and clinical trials. Key components of patient-specific CFD are covered briefly which include image segmentation, geometry reconstruction, mesh generation, fluid-structure interaction, and solver techniques.

Modelling mitral valvular dynamics-current trend and future directions

Dysfunction of mitral valve causes morbidity and premature mortality and remains a leading medical problem worldwide. Computational modelling aims to understand the biomechanics of human mitral valve and could lead to the development of new treatment, prevention and diagnosis of mitral valve diseases. Compared with the aortic valve, the mitral valve has been much less studied owing to its highly complex structure and strong interaction with the blood flow and the ventricles. However, the interest in mitral valve modelling is growing, and the sophistication level is increasing with the advanced development of computational technology and imaging tools. This review summarises the state-of-the-art modelling of the mitral valve, including static and dynamics models, models with fluid-structure interaction, and models with the left ventricle interaction. Challenges and future directions are also discussed.

Heart blood flow simulation: a perspective review

Cardiovascular disease (CVD), the leading cause of death today, incorporates a wide range of cardiovascular system malfunctions that affect heart functionality. It is believed that the hemodynamic loads exerted on the cardiovascular system, the left ventricle (LV) in particular, are the leading cause of CVD initiation and propagation. Moreover, it is believed that the diagnosis and prognosis of CVD at an early stage could reduce its high mortality and morbidity rate. Therefore, a set of robust clinical cardiovascular assessment tools has been introduced to compute the cardiovascular hemodynamics in order to provide useful insights to physicians to recognize indicators leading to CVD and also to aid the diagnosis of CVD. Recently, a combination of computational fluid dynamics (CFD) and different medical imaging tools, image-based CFD (IB-CFD), has been widely employed for cardiovascular functional assessment by providing reliable hemodynamic parameters. Even though the capability of CFD to provide reliable flow dynamics in general fluid mechanics problems has been widely demonstrated for many years, up to now, the clinical implications of the IB-CFD patient-specific LVs have not been applicable due to its limitations and complications. In this paper, we review investigations conducted to numerically simulate patient-specific human LV over the past 15 years using IB-CFD methods. Firstly, we divide different studies according to the different LV types (physiological and different pathological conditions) that have been chosen to reconstruct the geometry, and then discuss their contributions, methodologies, limitations, and findings. In this regard, we have studied CFD simulations of intraventricular flows and related cardiology insights, for (i) Physiological patient-specific LV models, (ii) Pathological heart patient-specific models, including myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy and hypoplastic left heart syndrome. Finally, we discuss the current stage of the IB-CFD LV simulations in order to mimic realistic hemodynamics of patient-specific LVs. We can conclude that heart flow simulation is on the right track for developing into a useful clinical tool for heart function assessment, by (i) incorporating most of heart structures' (such as heart valves) operations, and (ii) providing useful diagnostic indices based hemodynamic parameters, for routine adoption in clinical usage.

Numerical Modeling of Intraventricular Flow during Diastole after Implantation of BMHV

This work presents a numerical simulation of intraventricular flow after the implantation of a bileaflet mechanical heart valve at the mitral position. The left ventricle was simplified conceptually as a truncated prolate spheroid and its motion was prescribed based on that of a healthy subject. The rigid leaflet rotation was driven by the transmitral flow and hence the leaflet dynamics were solved using fluid-structure interaction approach. The simulation results showed that the bileaflet mechanical heart valve at the mitral position behaved similarly to that at the aortic position. Sudden area expansion near the aortic root initiated a clockwise anterior vortex, and the continuous injection of flow through the orifice resulted in further growth of the anterior vortex during diastole, which dominated the intraventricular flow. This flow feature is beneficial to preserving the flow momentum and redirecting the blood flow towards the aortic valve. To the best of our knowledge, this is the first attempt to numerically model intraventricular flow with the mechanical heart valve incorporated at the mitral position using a fluid-structure interaction approach. This study facilitates future patient-specific studies.

Implicit Partitioned Cardiovascular Fluid-Structure Interaction of the Heart Cycle Using Non-newtonian Fluid Properties and Orthotropic Material Behavior

Although image-based methods like MRI are well-developed, numerical simulation can help to understand human heart function. This function results from a complex interplay of biochemistry, structural mechanics, and blood flow. The complexity of the entire system often causes one of the three parts to be neglected, which limits the truth to reality of the reduced model. This paper focuses on the interaction of myocardial stress distribution and ventricular blood flow during diastole and systole in comparison to a simulation of the same patient-specific geometry with a given wall movement (Spiegel, Strömungsmechanischer Beitrag zur Planung von Herzoperationen, 2009). The orthotropic constitutive law proposed by Holzapfel et al. (Philos. Trans. R. Soc. Lond. Ser. A, 367:3445-3475, 2009) was implemented in a finite element package to model the passive behavior of the myocardium. Then, this law was modified for contraction. Via the ALE method, the structural model was coupled to a flow model which incorporates blood rheology and the circulatory system (Oertel, Prandtl-Essentials of Fluid Mechanics, 3rd edn, Springer Science + Business Media, 2010; Oertel et al., Modelling the Human Cardiac Fluid Mechanics, 3rd edn, Universitätsverlag Karlsruhe, 2009). Comparison reveals a good quantitative and qualitative agreement with respect to fluid flow. The motion of the myocardium is consistent with physiological observations. The calculated stresses and the distribution are within the physiological range and appear to be reasonable. The coupled model presented contains many features essential to cardiac function. It is possible to calculate wall stresses as well as the characteristic ventricular fluid flow. Based on the simulations we derive two characteristics to assess the health state quantitatively including solid and fluid mechanical aspects.

Design and application of pulse information acquisition and analysis system with dynamic recognition in traditional Chinese medicine

BACKGROUND

To design the pulse information which includes the parameter of pulse-position, pulse-number, pulse-shape and pulse-force acquisition and analysis system with function of dynamic recognition, and research the digitalization and visualization of some common cardiovascular mechanism of single pulse.

METHODS

To use some flexible sensors to catch the radial artery pressure pulse wave and utilize the high frequency B mode ultrasound scanning technology to synchronously obtain the information of radial extension and axial movement, by the way of dynamic images, then the gathered information was analyzed and processed together with ECG. Finally, the pulse information acquisition and analysis system was established which has the features of visualization and dynamic recognition, and it was applied to serve for ten healthy adults.

RESULTS

The new system overcome the disadvantage of one-dimensional pulse information acquisition and process method which was common used in current research area of pulse diagnosis in traditional Chinese Medicine, initiated a new way of pulse diagnosis which has the new features of dynamic recognition, two-dimensional information acquisition, multiplex signals combination and deep data mining.

CONCLUSIONS

The newly developed system could translate the pulse signals into digital, visual and measurable motion information of vessel.

Haemodynamic imaging of thoracic stent-grafts by computational fluid dynamics (CFD): presentation of a patient-specific method combining magnetic resonance imaging and numerical simulations

OBJECTIVES

In the last decade, there was been increasing interest in finding imaging techniques able to provide a functional vascular imaging of the thoracic aorta. The purpose of this paper is to present an imaging method combining magnetic resonance imaging (MRI) and computational fluid dynamics (CFD) to obtain a patient-specific haemodynamic analysis of patients treated by thoracic endovascular aortic repair (TEVAR).

METHODS

MRI was used to obtain boundary conditions. MR angiography (MRA) was followed by cardiac-gated cine sequences which covered the whole thoracic aorta. Phase contrast imaging provided the inlet and outlet profiles. A CFD mesh generator was used to model the arterial morphology, and wall movements were imposed according to the cine imaging. CFD runs were processed using the finite volume (FV) method assuming blood as a homogeneous Newtonian fluid.

RESULTS

Twenty patients (14 men; mean age 62.2 years) with different aortic lesions were evaluated. Four-dimensional mapping of velocity and wall shear stress were obtained, depicting different patterns of flow (laminar, turbulent, stenosis-like) and local alterations of parietal stress in-stent and along the native aorta.

CONCLUSIONS

A computational method using a combined approach with MRI appears feasible and seems promising to provide detailed functional analysis of thoracic aorta after stent-graft implantation.

KEY POINTS

• Functional vascular imaging of the thoracic aorta offers new diagnostic opportunities • CFD can model vascular haemodynamics for clinical aortic problems • Combining CFD with MRI offers patient specific method of aortic analysis • Haemodynamic analysis of stent-grafts could improve clinical management and follow-up.