MRI-based patient-specific human carotid atherosclerotic vessel material property variations in patients, vessel location and long-term follow up

Measurement of Layer-Specific Mechanical Properties of Intact Blood Vessels Based on Intravascular Optical Coherence Tomography

PURPOSE

The biomechanical analysis of stress and strain state of multilayered blood vessels has shown great importance in vascular pathology and physiology. However, there is a lack of method in measuring the mechanical property of each layer of a vascular sample without splitting up the wall.

METHODS

Here we develop a vascular inflation test method based on intravascular optical coherence tomography (IVOCT) imaging and inverse parametric estimation. We propose a three-step inverse parametric estimation method to solve the six constitutive parameters of the GOH models for the intima-media and adventitia of the coronaries simultaneously. A bilayer silicone vascular phantom inflation test and a virtual deformation test using finite element simulated data are conducted to evaluate the accuracy of the proposed method.

RESULTS

The virtual deformation test demonstrates that the errors of the constitutive constants are less than 2.56% determined by the proposed inverse parametric estimation method. The stress-strain curves of a bilayer silicone vascular phantom obtained based on the parameters determined by the proposed method match well with those obtained by the uniaxial test.

CONCLUSION

The proposed layer-specific vascular mechanical property measurement method provides a new experimental method for mechanical properties characterization of blood vessels. It also has the potential to be used for patient-specific mechanical properties estimation with IVOCT imaging in vivo.

The Need to Shift from Morphological to Structural Assessment for Carotid Plaque Vulnerability

Degree of luminal stenosis is generally considered to be an important indicator for judging the risk of atherosclerosis burden. However, patients with the same or similar degree of stenosis may have significant differences in plaque morphology and biomechanical factors. This study investigated three patients with carotid atherosclerosis within a similar range of stenosis. Using our developed fluid-structure interaction (FSI) modelling method, this study analyzed and compared the morphological and biomechanical parameters of the three patients. Although their degrees of carotid stenosis were similar, the plaque components showed a significant difference. The distribution range of time-averaged wall shear stress (TAWSS) of patient 2 was wider than that of patient 1 and patient 3. Patient 2 also had a much smaller plaque stress compared to the other two patients. There were significant differences in TAWSS and plaque stresses among three patients. This study suggests that plaque vulnerability is not determined by a single morphological factor, but rather by the combined structure. It is necessary to transform the morphological assessment into a structural assessment of the risk of plaque rupture.

Image-Based Finite Element Modeling Approach for Characterizing In Vivo Mechanical Properties of Human Arteries

Mechanical properties of the arterial walls could provide meaningful information for the diagnosis, management and treatment of cardiovascular diseases. Classically, various experimental approaches were conducted on dissected arterial tissues to obtain their stress-stretch relationship, which has limited value clinically. Therefore, there is a pressing need to obtain biomechanical behaviors of these vascular tissues in vivo for personalized treatment. This paper reviews the methods to quantify arterial mechanical properties in vivo. Among these methods, we emphasize a novel approach using image-based finite element models to iteratively determine the material properties of the arterial tissues. This approach has been successfully applied to arterial walls in various vascular beds. The mechanical properties obtained from the in vivo approach were compared to those from ex vivo experimental studies to investigate whether any discrepancy in material properties exists for both approaches. Arterial tissue stiffness values from in vivo studies generally were in the same magnitude as those from ex vivo studies, but with lower average values. Some methodological issues, including solution uniqueness and robustness; method validation; and model assumptions and limitations were discussed. Clinical applications of this approach were also addressed to highlight their potential in translation from research tools to cardiovascular disease management.

Patient-Specific Inverse Modeling of In Vivo Cardiovascular Mechanics with Medical Image-Derived Kinematics as Input Data: Concepts, Methods, and Applications

Inverse modeling approaches in cardiovascular medicine are a collection of methodologies that can provide non-invasive patient-specific estimations of tissue properties, mechanical loads, and other mechanics-based risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs. These methods have become available for medical applications mainly due to the continuing development of image-based kinematic techniques, the maturity of the associated theories describing cardiovascular function, and recent progress in computer science, modeling, and simulation engineering. Inverse method applications are multidisciplinary, requiring tailored solutions to the available clinical data, pathology of interest, and available computational resources. Herein, we review biomechanical modeling and simulation principles, methods of solving inverse problems, and techniques for image-based kinematic analysis. In the final section, the major advances in inverse modeling of human cardiovascular mechanics since its early development in the early 2000s are reviewed with emphasis on method-specific descriptions, results, and conclusions. We draw selected studies on healthy and diseased hearts, aortas, and pulmonary arteries achieved through the incorporation of tissue mechanics, hemodynamics, and fluid-structure interaction methods paired with patient-specific data acquired with medical imaging in inverse modeling approaches.

Quantifying Patient-Specific in vivo Coronary Plaque Material Properties for Accurate Stress/Strain Calculations: An IVUS-Based Multi-Patient Study

Introduction: Mechanical forces are closely associated with plaque progression and rupture. Precise quantifications of biomechanical conditions using in vivo image-based computational models depend heavily on the accurate estimation of patient-specific plaque mechanical properties. Currently, mechanical experiments are commonly performed on ex vivo cardiovascular tissues to determine plaque material properties. Patient-specific in vivo coronary material properties are scarce in the existing literature.

Methods:In vivo Cine intravascular ultrasound and virtual histology intravascular ultrasound (IVUS) slices were acquired at 20 plaque sites from 13 patients. A three-dimensional thin-slice structure-only model was constructed for each slice to obtain patient-specific in vivo material parameter values following an iterative scheme. Effective Young's modulus (YM) was calculated to indicate plaque stiffness for easy comparison purposes. IVUS-based 3D thin-slice models using in vivo and ex vivo material properties were constructed to investigate their impacts on plaque wall stress/strain (PWS/PWSn) calculations.

Results: The average YM values in the axial and circumferential directions for the 20 plaque slices were 599.5 and 1,042.8 kPa, respectively, 36.1% lower than those from published ex vivo data. The YM values in the circumferential direction of the softest and stiffest plaques were 103.4 and 2,317.3 kPa, respectively. The relative difference of mean PWSn on lumen using the in vivo and ex vivo material properties could be as high as 431%, while the relative difference of mean PWS was much lower, about 3.07% on average.

Conclusion: There is a large inter-patient and intra-patient variability in the in vivo plaque material properties. In vivo material properties have a great impact on plaque stress/strain calculations. In vivo plaque material properties have a greater impact on strain calculations. Large-scale-patient studies are needed to further verify our findings.

A surrogate model for plaque modeling in carotids based on Robin conditions calibrated by cine MRI data

We propose a surrogate model for the fluid-structure interaction (FSI) problem for the study of blood dynamics in carotid arteries in presence of plaque. This is based on the integration of a numerical model with subject-specific data and clinical imaging. We propose to model the plaque as part of the tissues surrounding the vessel wall through the application of an elastic support boundary condition. In order to characterize the plaque and other surrounding tissues, such as the close-by jugular vein, the elastic parameters of the boundary condition were spatially differentiated and their values were estimated by minimizing the discrepancies between computed vessel displacements and reference values obtained from CINE Magnetic Resonance Imaging data. We applied the model to three subjects with a degree of stenosis greater than 70%. We found that accounting for both plaque and jugular vein in the estimation of the elastic parameters increases the accuracy. In particular, in all patients, mismatches between computed and in vivo measured wall displacements were one to two orders of magnitude lower than the spatial resolution of the original MRI data. These results confirmed the validity of the proposed surrogate plaque model. We also compared fluid-dynamics results with those obtained in a fixed wall setting and in a full FSI model, used as gold standard, highlighting the better accordance of our results in comparison to the rigid ones.

Multi-patient study for coronary vulnerable plaque model comparisons: 2D/3D and fluid-structure interaction simulations

Several image-based computational models have been used to perform mechanical analysis for atherosclerotic plaque progression and vulnerability investigations. However, differences of computational predictions from those models have not been quantified at multi-patient level. In vivo intravascular ultrasound (IVUS) coronary plaque data were acquired from seven patients. Seven 2D/3D models with/without circumferential shrink, cyclic bending and fluid–structure interactions (FSI) were constructed for the seven patients to perform model comparisons and quantify impact of 2D simplification, circumferential shrink, FSI and cyclic bending plaque wall stress/strain (PWS/PWSn) and flow shear stress (FSS) calculations. PWS/PWSn and FSS averages from seven patients (388 slices for 2D and 3D thin-layer models) were used for comparison. Compared to 2D models with shrink process, 2D models without shrink process overestimated PWS by 17.26%. PWS change at location with greatest curvature change from 3D FSI models with/without cyclic bending varied from 15.07% to 49.52% for the seven patients (average = 30.13%). Mean Max-FSS, Min-FSS and Ave-FSS from the flow-only models under maximum pressure condition were 4.02%, 11.29% and 5.45% higher than those from full FSI models with cycle bending, respectively. Mean PWS and PWSn differences between FSI and structure-only models were only 4.38% and 1.78%. Model differences had noticeable patient variations. FSI and flow-only model differences were greater for minimum FSS predictions, notable since low FSS is known to be related to plaque progression. Structure-only models could provide PWS/PWSn calculations as good approximations to FSI models for simplicity and time savings in calculation.

Comparative study of variations in mechanical stress and strain of human blood vessels: mechanical reference for vascular cell mechano-biology

The diseases of human blood vessels are closely associated with local mechanical variations. A better understanding of the quantitative correlation in mechanical environment between the current mechano-biological studies and vascular physiological or pathological conditions in vivo is crucial for evaluating numerous existing results and exploring new factors for disease discovery. In this study, six representative human blood vessels with known experimental measurements were selected, and their stress and strain variations in vessel walls under different blood pressures were analyzed based on nonlinear elastic theory. The results suggest that conventional mechano-biological experiments seeking the different biological expressions of cells at high/low mechanical loadings are ambiguous as references for studying vascular diseases, because distinct "site-specific" characteristics appear in different vessels. The present results demonstrate that the inner surface of the vessel wall does not always suffer the most severe stretch under high blood pressures comparing to the outer surface. Higher tension on the outer surface of aortas supports the hypothesis of the outside-in inflammation dominated by aortic adventitial fibroblasts. These results indicate that cellular studies at different mechanical niches should be "disease-specific" as well. The present results demonstrate considerable stress gradients across the wall thickness, which indicate micro-scale mechanical variations existing around the vascular cells, and imply that the physiological or pathological changes are not static processes confined within isolated regions, but are coupled with dynamic cell behaviors such as migration. The results suggest that the stress gradients, as well as the mechanical stresses and strains, are key factors constituting the mechanical niches, which may shed new light on "factor-specific" experiments of vascular cell mechano-biology.