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Futami K, Misaki K, Uno T, Nambu I, Kamide T, Nakada M. Characterization of Maximum Wall Shear Stress Points in Unruptured Cerebral Aneurysms Using Four-dimensional Flow Magnetic Resonance Imaging. Clin Neuroradiol 2024:10.1007/s00062-024-01436-w. [PMID: 39017672 DOI: 10.1007/s00062-024-01436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Maximum wall shear stress (maxWSS) points of unruptured cerebral aneurysms (UCAs) may cause wall remodeling leading to rupture. We characterized maxWSS points and their inherent intra-aneurysmal flow structures in a sizable cohort of saccular UCAs using four-dimensional (4D) flow magnetic resonance imaging (MRI). METHODS After contrast administration, 50 saccular UCAs were subjected to 4D flow MRI using a 1.5 T MRI scanner. Post-processing of obtained data was performed using commercially available software. The maxWSS points and maxWSS values were evaluated. The maxWSS values were statistically compared between aneurysm groups. RESULTS The maxWSS point was located on the aneurysm apex in 9 (18.0%), body in 2 (4.0%), and neck in 39 (78.0%) UCAs. The inherent intra-aneurysmal flow structure of the maxWSS point was an inflow zone in 34 (68.0%) UCAs, an inflow jet in 8 (16.0%), and an impingement zone in 8 (16.0%). The maxWSS point on the neck had significantly higher maxWSS values than those points on the other wall areas (P = 0.008). The maxWSS values of the maxWSS points on the apex and on the impingement zone were not significantly different compared with those of the other maxWSS points. CONCLUSION The maxWSS points existed preferentially on the aneurysmal neck adjacent to the inflow zone with higher maxWSS values. The maxWSS points existed occasionally on the aneurysmal apex adjacent to the impingement zone. 4D flow MRI may be helpful to discriminate saccular UCAs with higher-risk maxWSS points that can cause wall remodeling leading to rupture.
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Affiliation(s)
- Kazuya Futami
- Department of Neurosurgery, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers, 123 Nodera, Oyabe, 932-8503, Toyama, Japan.
| | - Kouichi Misaki
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Takehiro Uno
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Iku Nambu
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
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Winter P, Berhane H, Moore JE, Aristova M, Reichl T, Wollenberg J, Richter A, Jarvis KB, Patel A, Caprio FZ, Abdalla RN, Ansari SA, Markl M, Schnell S. Automated intracranial vessel segmentation of 4D flow MRI data in patients with atherosclerotic stenosis using a convolutional neural network. FRONTIERS IN RADIOLOGY 2024; 4:1385424. [PMID: 38895589 PMCID: PMC11183785 DOI: 10.3389/fradi.2024.1385424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
Introduction Intracranial 4D flow MRI enables quantitative assessment of hemodynamics in patients with intracranial atherosclerotic disease (ICAD). However, quantitative assessments are still challenging due to the time-consuming vessel segmentation, especially in the presence of stenoses, which can often result in user variability. To improve the reproducibility and robustness as well as to accelerate data analysis, we developed an accurate, fully automated segmentation for stenosed intracranial vessels using deep learning. Methods 154 dual-VENC 4D flow MRI scans (68 ICAD patients with stenosis, 86 healthy controls) were retrospectively selected. Manual segmentations were used as ground truth for training. For automated segmentation, deep learning was performed using a 3D U-Net. 20 randomly selected cases (10 controls, 10 patients) were separated and solely used for testing. Cross-sectional areas and flow parameters were determined in the Circle of Willis (CoW) and the sinuses. Furthermore, the flow conservation error was calculated. For statistical comparisons, Dice scores (DS), Hausdorff distance (HD), average symmetrical surface distance (ASSD), Bland-Altman analyses, and interclass correlations were computed using the manual segmentations from two independent observers as reference. Finally, three stenosis cases were analyzed in more detail by comparing the 4D flow-based segmentations with segmentations from black blood vessel wall imaging (VWI). Results Training of the network took approximately 10 h and the average automated segmentation time was 2.2 ± 1.0 s. No significant differences in segmentation performance relative to two independent observers were observed. For the controls, mean DS was 0.85 ± 0.03 for the CoW and 0.86 ± 0.06 for the sinuses. Mean HD was 7.2 ± 1.5 mm (CoW) and 6.6 ± 3.7 mm (sinuses). Mean ASSD was 0.15 ± 0.04 mm (CoW) and 0.22 ± 0.17 mm (sinuses). For the patients, the mean DS was 0.85 ± 0.04 (CoW) and 0.82 ± 0.07 (sinuses), the HD was 8.4 ± 3.1 mm (CoW) and 5.7 ± 1.9 mm (sinuses) and the mean ASSD was 0.22 ± 0.10 mm (CoW) and 0.22 ± 0.11 mm (sinuses). Small bias and limits of agreement were observed in both cohorts for the flow parameters. The assessment of the cross-sectional lumen areas in stenosed vessels revealed very good agreement (ICC: 0.93) with the VWI segmentation but a consistent overestimation (bias ± LOA: 28.1 ± 13.9%). Discussion Deep learning was successfully applied for fully automated segmentation of stenosed intracranial vasculatures using 4D flow MRI data. The statistical analysis of segmentation and flow metrics demonstrated very good agreement between the CNN and manual segmentation and good performance in stenosed vessels. To further improve the performance and generalization, more ICAD segmentations as well as other intracranial vascular pathologies will be considered in the future.
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Affiliation(s)
- Patrick Winter
- Department of Medical Physics, Faculty of Mathematics and Natural Sciences, University of Greifswald, Greifswald, Germany
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Haben Berhane
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Jackson E. Moore
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Maria Aristova
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicacgo, IL, United States
| | - Teresa Reichl
- Department of Experimental Physics V, University of Wuerzburg, Wuerzburg, Germany
| | - Julian Wollenberg
- Department of Medical Physics, Faculty of Mathematics and Natural Sciences, University of Greifswald, Greifswald, Germany
- Department of Diagnostic Radiology, University Hospital of Greifswald, Greifswald, Germany
| | - Adam Richter
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Kelly B. Jarvis
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Abhinav Patel
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Fan Z. Caprio
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicacgo, IL, United States
| | - Ramez N. Abdalla
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Sameer A. Ansari
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicacgo, IL, United States
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Susanne Schnell
- Department of Medical Physics, Faculty of Mathematics and Natural Sciences, University of Greifswald, Greifswald, Germany
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
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Wang B, Shen C, Su Z, Nie X, Zhao J, Qiu S, Li Y. Correlation between the rate of morphological changes and rupture of intracranial aneurysms during one cardiac cycle analyzed by 4D-CTA. Front Neurol 2023; 14:1235312. [PMID: 37849835 PMCID: PMC10577209 DOI: 10.3389/fneur.2023.1235312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Objective This study aimed to analyze the relationship between the rate of morphological changes and intracranial aneurysm rupture during the cardiac cycle. Methods Eighty-four patients with intracranial aneurysms were retrospectively analyzed and divided into the rupture (42 cases) and unruptured (42 cases) groups. Four-dimensional computed tomography angiography (4D-CTA) was performed to collect quantitative parameters of aneurysm morphology and calculate the morphological change rate. The potential factors associated with aneurysm rupture were determined by comparing the general clinical data and rate of change in the location and morphology of the aneurysm between the two groups. Results Each morphological change rate in the rupture group was generally higher than that of the unruptured group. The rate of dome height change and aneurysm volume change were independent factors associated with aneurysm rupture. ROC curve analysis revealed that the diagnostic accuracy of the aneurysm volume change rate was higher. When the volume change rate was 12.33%, the sensitivity and specificity of rupture were 90.5 and 55.8%, respectively. Conclusion The rate of change in dome height and volume of intracranial aneurysms during one cardiac cycle were independent factors associated with aneurysm rupture.
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Affiliation(s)
- Binghao Wang
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Neurosurgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chengen Shen
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Zhongzhou Su
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Xiaohu Nie
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Jingjing Zhao
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Hospital Infection Control, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Sheng Qiu
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Yuntao Li
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
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Rothenberger SM, Patel NM, Zhang J, Schnell S, Craig BA, Ansari SA, Markl M, Vlachos PP, Rayz VL. Automatic 4D Flow MRI Segmentation Using the Standardized Difference of Means Velocity. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:2360-2373. [PMID: 37028010 PMCID: PMC10474251 DOI: 10.1109/tmi.2023.3251734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We present a method to automatically segment 4D flow magnetic resonance imaging (MRI) by identifying net flow effects using the standardized difference of means (SDM) velocity. The SDM velocity quantifies the ratio between the net flow and observed flow pulsatility in each voxel. Vessel segmentation is performed using an F-test, identifying voxels with significantly higher SDM velocity values than background voxels. We compare the SDM segmentation algorithm against pseudo-complex difference (PCD) intensity segmentation of 4D flow measurements in in vitro cerebral aneurysm models and 10 in vitro Circle of Willis (CoW) datasets. We also compared the SDM algorithm to convolutional neural network (CNN) segmentation in 5 thoracic vasculature datasets. The in vitro flow phantom geometry is known, while the ground truth geometries for the CoW and thoracic aortas are derived from high-resolution time-of-flight (TOF) magnetic resonance angiography and manual segmentation, respectively. The SDM algorithm demonstrates greater robustness than PCD and CNN approaches and can be applied to 4D flow data from other vascular territories. The SDM to PCD comparison demonstrated an approximate 48% increase in sensitivity in vitro and 70% increase in the CoW, respectively; the SDM and CNN sensitivities were similar. The vessel surface derived from the SDM method was 46% closer to the in vitro surfaces and 72% closer to the in vitro TOF surfaces than the PCD approach. The SDM and CNN approaches both accurately identify vessel surfaces. The SDM algorithm is a repeatable segmentation method, enabling reliable computation of hemodynamic metrics associated with cardiovascular disease.
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Maroun A, Quinn S, Dushfunian D, Weiss EK, Allen BD, Carr JC, Markl M. Clinical Applications of Four-Dimensional Flow MRI. Magn Reson Imaging Clin N Am 2023; 31:451-460. [PMID: 37414471 DOI: 10.1016/j.mric.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Four-dimensional flow MRI is a powerful phase contrast technique used for assessing three-dimensional (3D) blood flow dynamics. By acquiring a time-resolved velocity field, it enables flexible retrospective analysis of blood flow that can include qualitative 3D visualization of complex flow patterns, comprehensive assessment of multiple vessels, reliable placement of analysis planes, and calculation of advanced hemodynamic parameters. This technique provides several advantages over routine two-dimensional flow imaging techniques, allowing it to become part of clinical practice at major academic medical centers. In this review, we present the current state-of-the-art cardiovascular, neurovascular, and abdominal applications.
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Affiliation(s)
- Anthony Maroun
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA.
| | - Sandra Quinn
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - David Dushfunian
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Elizabeth K Weiss
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
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Sache A, Reymond P, Brina O, Jung B, Farhat M, Vargas MI. Near-wall hemodynamic parameters quantification in in vitro intracranial aneurysms with 7 T PC-MRI. MAGMA (NEW YORK, N.Y.) 2023; 36:295-308. [PMID: 37072539 PMCID: PMC10140017 DOI: 10.1007/s10334-023-01082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Wall shear stress (WSS) and its derived spatiotemporal parameters have proven to play a major role on intracranial aneurysms (IAs) growth and rupture. This study aims to demonstrate how ultra-high field (UHF) 7 T phase contrast magnetic resonance imaging (PC-MRI) coupled with advanced image acceleration techniques allows a highly resolved visualization of near-wall hemodynamic parameters patterns in in vitro IAs, paving the way for more robust risk assessment of their growth and rupture. MATERIALS AND METHODS We performed pulsatile flow measurements inside three in vitro models of patient-specific IAs using 7 T PC-MRI. To this end, we built an MRI-compatible test bench, which faithfully reproduced a typical physiological intracranial flow rate in the models. RESULTS The ultra-high field 7 T images revealed WSS patterns with high spatiotemporal resolution. Interestingly, the high oscillatory shear index values were found in the core of low WSS vortical structures and in flow stream intersecting regions. In contrast, maxima of WSS occurred around the impinging jet sites. CONCLUSIONS We showed that the elevated signal-to-noise ratio arising from 7 T PC-MRI enabled to resolve high and low WSS patterns with a high degree of detail.
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Affiliation(s)
- Antoine Sache
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | - Philippe Reymond
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Farhat
- Department of Mechanical Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Roberts GS, Hoffman CA, Rivera-Rivera LA, Berman SE, Eisenmenger LB, Wieben O. Automated hemodynamic assessment for cranial 4D flow MRI. Magn Reson Imaging 2023; 97:46-55. [PMID: 36581214 PMCID: PMC9892280 DOI: 10.1016/j.mri.2022.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
Cranial 4D flow MRI post-processing typically involves manual user interaction which is time-consuming and associated with poor repeatability. The primary goal of this study is to develop a robust quantitative velocity tool (QVT) that utilizes threshold-based segmentation techniques to improve segmentation quality over prior approaches based on centerline processing schemes (CPS) that utilize k-means clustering segmentation. This tool also includes an interactive 3D display designed for simplified vessel selection and automated hemodynamic visualization and quantification. The performances of QVT and CPS were compared in vitro in a flow phantom and in vivo in 10 healthy participants. Vessel segmentations were compared with ground-truth computed tomography in vitro (29 locations) and manual segmentation in vivo (13 locations) using linear regression. Additionally, QVT and CPS MRI flow rates were compared to perivascular ultrasound flow in vitro using linear regression. To assess internal consistency of flow measures in vivo, conservation of flow was assessed at vessel junctions using linear regression and consistency of flow along vessel segments was analyzed by fitting a Gaussian distribution to a histogram of normalized flow values. Post-processing times were compared between the QVT and CPS using paired t-tests. Vessel areas segmented in vitro (CPS: slope = 0.71, r = 0.95 and QVT: slope = 1.03, r = 0.95) and in vivo (CPS: slope = 0.61, r = 0.96 and QVT: slope = 0.93, r = 0.96) were strongly correlated with ground-truth area measurements. However, CPS (using k-means segmentation) consistently underestimated vessel areas. Strong correlations were observed between QVT and ultrasound flow (slope = 0.98, r = 0.96) as well as flow at junctions (slope = 1.05, r = 0.98). Mean and standard deviation of flow along vessel segments was 9.33e-16 ± 3.05%. Additionally, the QVT demonstrated excellent interobserver agreement and significantly reduced post-processing by nearly 10 min (p < 0.001). By completely automating post-processing and providing an easy-to-use 3D visualization interface for interactive vessel selection and hemodynamic quantification, the QVT offers an efficient, robust, and repeatable means to analyze cranial 4D flow MRI. This software is freely available at: https://github.com/uwmri/QVT.
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Affiliation(s)
- Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA.
| | - Carson A Hoffman
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA
| | - Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI 53792, USA.
| | - Sara E Berman
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, J5/1 Mezzanine, Madison, WI 53792, USA.
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366 Clinical Science Center, Madison, WI 53792, USA.
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue #1005, Madison, WI 53705, USA; Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/366 Clinical Science Center, Madison, WI 53792, USA.
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Hurd ER, Iffrig E, Jiang D, Oshinski JN, Timmins LH. Flow-based method demonstrates improved accuracy for calculating wall shear stress in arterial flows from 4D flow MRI data. J Biomech 2023; 146:111413. [PMID: 36535100 PMCID: PMC9845191 DOI: 10.1016/j.jbiomech.2022.111413] [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: 06/15/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Four-dimensional flow magnetic resonance imaging (i.e., 4D flow MRI) has become a valuable tool for the in vivo assessment of blood flow within large vessels and cardiac chambers. As wall shear stress (WSS) has been correlated with the development and progression of cardiovascular disease, focus has been directed at developing techniques to quantify WSS directly from 4D flow MRI data. The goal of this study was to compare the accuracy of two such techniques - termed the velocity and flow-based methods - in the setting of simplified and complex flow scenarios. Synthetic MR data were created from exact solutions to the Navier-Stokes equations for the steady and pulsatile flow of an incompressible, Newtonian fluid through a rigid cylinder. In addition, synthetic MR data were created from the predicted velocity fields derived from a fluid-structure interaction (FSI) model of pulsatile flow through a thick-walled, multi-layered model of the carotid bifurcation. Compared to the analytical solutions for steady and pulsatile flow, the flow-based method demonstrated greater accuracy than the velocity-based method in calculating WSS across all changes in fluid velocity/flow rate, tube radius, and image signal-to-noise (p < 0.001). Furthermore, the velocity-based method was more sensitive to boundary segmentation than the flow-based method. When compared to results from the FSI model, the flow-based method demonstrated greater accuracy than the velocity-based method with average differences in time-averaged WSS of 0.31 ± 1.03 Pa and 0.45 ± 1.03 Pa, respectively (p <0.005). These results have implications on the utility, accuracy, and clinical translational of methods to determine WSS from 4D flow MRI.
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Affiliation(s)
- Elliott R Hurd
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Elizabeth Iffrig
- Division of Allergy, Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
| | - David Jiang
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - John N Oshinski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Lucas H Timmins
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA.
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Risk of subarachnoid haemorrhages and aneurysms in Danish People Living With HIV, a nationwide cohort study. AIDS 2022; 36:1287-1294. [PMID: 35471643 DOI: 10.1097/qad.0000000000003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE It remains unclear whether people with HIV (PWH) have increased risk of aneurysms. We aimed to investigate if the risk of subarachnoid haemorrhage, cerebral aneurysm, aortic aneurysm and other arterial aneurysms and dissections is increased in PWH compared with the general population. DESIGN We performed a nationwide population-based matched cohort study. METHODS We compared PWH with age-matched and sex-matched comparison cohort members to calculate incidence rate ratios (IRR) of subarachnoid haemorrhage, cerebral aneurysm, aortic aneurysm and other arterial aneurysms and dissections as well as surgery for these conditions. RESULTS We included all PWH, who were Danish residents and treated at a HIV healthcare centre between January 1995 and February 2018 (n = 6935) and an age-matched and sex-matched comparison cohort (n = 55 480). PWH had increased risk of subarachnoid haemorrhage (IRR 1.7, 95% CI, 1.1-2.6), but no increased risk of surgery for this condition. PWH had no increased risk of cerebral aneurysm or aortic aneurysm or surgery for these conditions. The risk of other arterial aneurysms and dissections was increased in PWH (IRR 2.0, 95% CI, 1.4-2.9), but this only applied for PWH who reported intravenous substance use as route of HIV transmission (IRR 18.4, 95% CI, 9.3-36.6), and not for PWH without reported injection drug use (IRR 1.2, 95% CI, 0.73-1.7). CONCLUSION PWH were not at an increased risk of cerebral, aortic or other arterial aneurysms and dissections. Although PWH were at an increased risk of subarachnoid haemorrhage, subarachnoid haemorrhages were rare among PWH.
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Pravdivtseva MS, Gaidzik F, Berg P, Ulloa P, Larsen N, Jansen O, Hövener JB, Salehi Ravesh M. Influence of Spatial Resolution and Compressed SENSE Acceleration Factor on Flow Quantification with 4D Flow MRI at 3 Tesla. Tomography 2022; 8:457-478. [PMID: 35202203 PMCID: PMC8880336 DOI: 10.3390/tomography8010038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Four-dimensional (4D) flow MRI allows quantifying flow in blood vessels–non invasively and in vivo. The clinical use of 4D flow MRI in small vessels, however, is hampered by long examination times and limited spatial resolution. Compressed SENSE (CS-SENSE) is a technique that can accelerate 4D flow dramatically. Here, we investigated the effect of spatial resolution and CS acceleration on flow measurements by using 4D flow MRI in small vessels in vitro at 3 T. We compared the flow in silicon tubes (inner diameters of 2, 3, 4, and 5 mm) measured with 4D flow MRI, accelerated with four CS factors (CS = 2.5, 4.5, 6.5, and 13) and three voxel sizes (0.5, 1, and 1.5 mm3) to 2D flow MRI and a flow sensor. Additionally, the velocity field in an aneurysm model acquired with 4D flow MRI was compared to the one simulated with computational fluid dynamics (CFD). A strong correlation was observed between flow sensor, 2D flow MRI, and 4D flow MRI (rho > 0.94). The use of fewer than seven voxels per vessel diameter (nROI) resulted in an overestimation of flow in more than 5% of flow measured with 2D flow MRI. A negative correlation (rho = −0.81) between flow error and nROI were found for CS = 2.5 and 4.5. No statistically significant impact of CS factor on differences in flow rates was observed. However, a trend of increased flow error with increased CS factor was observed. In an aneurysm model, the peak velocity and stagnation zone were detected by CFD and all 4D flow MRI variants. The velocity difference error in the aneurysm sac did not exceed 11% for CS = 4.5 in comparison to CS = 2.5 for all spatial resolutions. Therefore, CS factors from 2.5–4.5 can appear suitable to improve spatial or temporal resolution for accurate quantification of flow rate and velocity. We encourage reporting the number of voxels per vessel diameter to standardize 4D flow MRI protocols.
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Affiliation(s)
- Mariya S. Pravdivtseva
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
- Correspondence: ; Tel.: +49-(0)-431-500-16-533
| | - Franziska Gaidzik
- Department of Fluid Dynamics and Technical Flows, Research Campus STIMULATE, Magdeburg University, 39106 Magdeburg, Germany; (F.G.); (P.B.)
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, Research Campus STIMULATE, Magdeburg University, 39106 Magdeburg, Germany; (F.G.); (P.B.)
| | - Patricia Ulloa
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, 24105 Kiel, Germany; (N.L.); (O.J.)
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, 24105 Kiel, Germany; (N.L.); (O.J.)
| | - Jan-Bernd Hövener
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
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11
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Abstract
Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time-resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health. The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain-wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow-up of interventions aiming to restore a normal cerebral circulation. Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest.
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Affiliation(s)
- Anders Wåhlin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science and Neurosciences, Umeå University, Umeå, Sweden
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12
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Roberts GS, Loecher MW, Spahic A, Johnson KM, Turski PA, Eisenmenger LB, Wieben O. Virtual injections using 4D flow MRI with displacement corrections and constrained probabilistic streamlines. Magn Reson Med 2021; 87:2495-2511. [PMID: 34971458 PMCID: PMC8884720 DOI: 10.1002/mrm.29134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Streamlines from 4D-flow MRI have been used clinically for intracranial blood-flow tracking. However, deterministic and stochastic errors degrade streamline quality. The purpose of this study is to integrate displacement corrections, probabilistic streamlines, and novel fluid constraints to improve selective blood-flow tracking and emulate "virtual bolus injections." METHODS Both displacement artifacts (deterministic) and velocity noise (stochastic) inherently occur during phase-contrast MRI acquisitions. Here, two displacement correction methods, single-step and iterative, were tested in silico with simulated displacements and were compared with ground-truth velocity fields. Next, the effects of combining displacement corrections and constrained probabilistic streamlines were performed in 10 healthy volunteers using time-averaged 4D-flow data. Measures of streamline length and depth into vasculature were then compared with streamlines generated with no corrections and displacement correction alone using one-way repeated-measures analysis of variance and Friedman's tests. Finally, virtual injections with improved streamlines were generated for three intracranial pathology cases. RESULTS Iterative displacement correction outperformed the single-step method in silico. In volunteers, the combination of displacement corrections and constrained probabilistic streamlines allowed for significant improvements in streamline length and increased the number of streamlines entering the circle of Willis relative to streamlines with no corrections and displacement correction alone. In the pathology cases, virtual injections with improved streamlines were qualitatively similar to dynamic arterial spin labeling images and allowed for forward/reverse selective flow tracking to characterize cerebrovascular malformations. CONCLUSION Virtual injections with improved streamlines from 4D-flow MRI allow for flexible, robust, intracranial flow tracking.
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Affiliation(s)
- Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael W Loecher
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Alma Spahic
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Patrick A Turski
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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13
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Acosta JM, Cayron AF, Dupuy N, Pelli G, Foglia B, Haemmerli J, Allémann E, Bijlenga P, Kwak BR, Morel S. Effect of Aneurysm and Patient Characteristics on Intracranial Aneurysm Wall Thickness. Front Cardiovasc Med 2021; 8:775307. [PMID: 34957259 PMCID: PMC8692777 DOI: 10.3389/fcvm.2021.775307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The circle of Willis is a network of arteries allowing blood supply to the brain. Bulging of these arteries leads to formation of intracranial aneurysm (IA). Subarachnoid hemorrhage (SAH) due to IA rupture is among the leading causes of disability in the western world. The formation and rupture of IAs is a complex pathological process not completely understood. In the present study, we have precisely measured aneurysmal wall thickness and its uniformity on histological sections and investigated for associations between IA wall thickness/uniformity and commonly admitted risk factors for IA rupture. Methods: Fifty-five aneurysm domes were obtained at the Geneva University Hospitals during microsurgery after clipping of the IA neck. Samples were embedded in paraffin, sectioned and stained with hematoxylin-eosin to measure IA wall thickness. The mean, minimum, and maximum wall thickness as well as thickness uniformity was measured for each IA. Clinical data related to IA characteristics (ruptured or unruptured, vascular location, maximum dome diameter, neck size, bottleneck factor, aspect and morphology), and patient characteristics [age, smoking, hypertension, sex, ethnicity, previous SAH, positive family history for IA/SAH, presence of multiple IAs and diagnosis of polycystic kidney disease (PKD)] were collected. Results: We found positive correlations between maximum dome diameter or neck size and IA wall thickness and thickness uniformity. PKD patients had thinner IA walls. No associations were found between smoking, hypertension, sex, IA multiplicity, rupture status or vascular location, and IA wall thickness. No correlation was found between patient age and IA wall thickness. The group of IAs with non-uniform wall thickness contained more ruptured IAs, women and patients harboring multiple IAs. Finally, PHASES and ELAPSS scores were positively correlated with higher IA wall heterogeneity. Conclusion: Among our patient and aneurysm characteristics of interest, maximum dome diameter, neck size and PKD were the three factors having the most significant impact on IA wall thickness and thickness uniformity. Moreover, wall thickness heterogeneity was more observed in ruptured IAs, in women and in patients with multiple IAs. Advanced medical imaging allowing in vivo measurement of IA wall thickness would certainly improve personalized management of the disease and patient care.
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Affiliation(s)
- Jason M. Acosta
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne F. Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Nicolas Dupuy
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Graziano Pelli
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bernard Foglia
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Haemmerli
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Brenda R. Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Sandrine Morel
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14
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Wang Y, Sun J, Li R, Liu P, Liu X, Ji J, Chen C, Chen Y, Qi H, Li Y, Zhang L, Jia L, Peng F, Fu M, Wang Y, Xu M, Kong C, Xia S, Wang X, He L, Zhang Q, Chen Z, Liu A, Li Y, Lv M, Chen H. Increased aneurysm wall permeability colocalized with low wall shear stress in unruptured saccular intracranial aneurysm. J Neurol 2021; 269:2715-2719. [PMID: 34731309 DOI: 10.1007/s00415-021-10869-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022]
Abstract
Aneurysm wall permeability has recently emerged as an in vivo marker of aneurysm wall remodeling. We sought to study the spatial relationship between hemodynamic forces derived from 4D-flow MRI and aneurysm wall permeability by DCE-MRI in a region-based analysis of unruptured saccular intracranial aneurysms (IAs). We performed 4D-flow MRI and DCE-MRI on patients with unruptured IAs of ≥ 5 mm to measure hemodynamic parameters, including wall shear stress (WSS), oscillatory shear index (OSI), WSS temporal (WSSGt) and spatial (WSSGs) gradient, and aneurysm wall permeability (Ktrans) in different sectors of aneurysm wall defined by evenly distributed radial lines emitted from the aneurysm center. The spatial association between Ktrans and hemodynamic parameters measured at the sector level was evaluated. Thirty-one patients were scanned. Ktrans not only varied between aneurysms but also demonstrated spatial heterogeneity within an aneurysm. Among all 159 sectors, higher Ktrans was associated with lower WSS, which was seen in both Spearman's correlation analysis (rho = - 0.18, p = 0.025) and linear regression analysis using generalized estimating equation to account for correlations between multiple sectors of the same aneurysm (regression coefficient = - 0.33, p = 0.006). Aneurysm wall permeability by DCE-MRI was shown to be spatially heterogenous in unruptured saccular IAs and associated with local WSS by 4D-flow MRI.
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Affiliation(s)
- Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xian Liu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Chunmiao Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Yu Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Haikun Qi
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Yunduo Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | | | - Min Xu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Chunli Kong
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Shuiwei Xia
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Clinical College of The Affiliated Central Hospital, Lishui University, Lishui, Zhejiang, China
| | - Xiaole Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Zhensen Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
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15
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Lauric A, Hippelheuser JE, Malek AM. Moments of Intra-Dome Velocity Distribution as Robust Predictors of Rupture Status in Cerebral Aneurysms. World Neurosurg 2021; 158:e334-e343. [PMID: 34740832 DOI: 10.1016/j.wneu.2021.10.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wall shear stress (WSS), the spatial gradient of flow velocity at luminal surface, has been employed for aneurysmal hemodynamic analysis, but it is sensitive to surface irregularities and noise. We devised a volumetric approach to evaluate discriminant power of intra-dome flow velocity distribution and modal analysis in rupture status determination compared with previously described WSS analysis. METHODS Catheter three-dimensional rotational angiographic datasets matched for volume were segmented in 20 sidewall aneurysms (10 ruptured), computational fluid dynamics simulations were performed, and velocity distributions were extracted from mesh-independent isometric sampling followed by moment analysis (mean, variance, skewness, and kurtosis). Univariate and multivariate analysis was used to evaluate discriminant performance of velocity moments. Sensitivity of velocity moments and WSS was evaluated to bleb presence and surface irregularity using digital bleb removal and surface noise addition. RESULTS Velocity moments of ruptured aneurysms showed higher skewness (2.45 ± 0.57 vs. 1.36 ± 0.82, P = 0.003) and kurtosis (11.83 ± 4.77 vs. 6.05 ± 4.65, P = 0.01) with lower mean (0.019 ± 0.01 vs. 0.038 ± 0.02, P = 0.03) compared with unruptured lesions; in multivariate modeling, skewness alone emerged as best predictor (area under the curve = 0.88). Bleb removal increased low WSS by 548%, and surface noise decreased it by 85.8% while having a smaller (<7%) effect on velocity skewness and kurtosis. CONCLUSIONS High aneurysm dome flow velocity skewness and kurtosis suggest an exponential distribution in ruptured lesions, with high peaks at low velocities, consistent with areas of slow flow. In contrast to WSS-based techniques, this approach is robust against surface variations, with promising improved rupture status discriminant performance that requires further validation in expanded future studies.
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Affiliation(s)
- Alexandra Lauric
- Cerebrovascular Hemodynamics Laboratory, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - James E Hippelheuser
- Cerebrovascular Hemodynamics Laboratory, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Adel M Malek
- Cerebrovascular Hemodynamics Laboratory, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA.
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16
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Complex and continuous change in hypothetic risk of rupture of intracranial cerebral aneurysms – Bleb mandala –. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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17
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Pei Y, Xu Z, Liang G, Jin H, Duan Y, Yang B, Qiao X, You H, Xing D. Risk Factors of Anterior Circulation Intracranial Aneurysm Rupture: Extracranial Carotid Artery Tortuosity and Aneurysm Morphologic Parameters. Front Neurol 2021; 12:693549. [PMID: 34322085 PMCID: PMC8313111 DOI: 10.3389/fneur.2021.693549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: This study was conducted to explore the risk factors of anterior circulation intracranial aneurysm rupture based on extracranial carotid artery (ECA) tortuosity. Methods: This retrospective study, conducted from January 1, 2017, to March 1, 2021, collected and reviewed the clinical and imaging data of 308 patients with anterior circulation intracranial aneurysm [133 (43.2%) patients in the ruptured aneurysm group; 175 (56.8%) patients in the unruptured aneurysm group]. Computed tomography angiography (CTA) of the head and neck was used to determine the ECA tortuosity (normal, simple tortuosity, kink, coil) and the morphologic parameters of the aneurysms. The relationship of aneurysm rupture to ECA tortuosity and the morphologic parameters were analyzed. Results: After univariate analysis, kink, angle of flow inflow (FA), aspect ratio (AR), aneurysm length (L), the distance from the tortuosity to the aneurysm (distance), and size ratio (SR) were significantly correlated with anterior circulation intracranial aneurysm rupture (p < 0.05). Spearman correlation analysis showed that ECA tortuosity was correlated with FA and SR (p < 0.05). Multiple logistic analyses showed that FA [odds ratio (OR), 1.013; 95% CI, 1.002–1.025], SR (OR, 1.521; 95% CI, 1.054–2.195), and kink (OR, 1.823; 95% CI, 1.074–3.096) were independently associated with aneurysm rupture. Conclusion: Study results suggest that FA, SR, and ECA kink were independent risk factors associated with anterior circulation intracranial aneurysm rupture.
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Affiliation(s)
- Yusong Pei
- Jinzhou Medical University General Hospital of Northern Theater Command Postgraduate Training Base, Shenyang, China
| | - Zhihua Xu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Guobiao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Hai Jin
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yang Duan
- Center for Neuroimaging, General Hospital of Northern Theater Command, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xinxin Qiao
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Hongrui You
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Dengxiang Xing
- Center for Medical Data, General Hospital of Northern Theater Command, Shenyang, China
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18
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Zhang M, Peng F, Tong X, Feng X, Li Y, Chen H, Niu H, Zhang B, Song G, Li Y, Liu P, Liu A, Li R. Associations between haemodynamics and wall enhancement of intracranial aneurysm. Stroke Vasc Neurol 2021; 6:467-475. [PMID: 33637615 PMCID: PMC8485248 DOI: 10.1136/svn-2020-000636] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have reported about inflammation processes (IPs) that play important roles in aneurysm formation and rupture, which could be driven by blood flow. IPs can be identified using aneurysmal wall enhancement (AWE) on high-resolution black-blood MRI (BB-MRI) and blood flow haemodynamics can be demonstrated by four-dimensional-flow MRI (4D-flow MRI). Thus, this study investigated the associations between AWE and haemodynamics in unruptured intracranial aneurysms (IA) by combining 4D-flow MRI and high-resolution BB-MRI. MATERIALS AND METHODS Between April 2014 and October 2017, 48 patients with 49 unruptured IA who underwent both 4D-flow MRI and high-resolution BB-MRI were retrospectively included in this study. The haemodynamic parameters demonstrated using 4D-flow MRI were compared between different AWE patterns using the Kruskal-Wallis test and ordinal regression. RESULTS The results of Kruskal-Wallis test showed that the average wall shear stress in the IA (WSSavg-IA), maximum through-plane velocity in the adjacent parent artery, inflow jet patterns and the average vorticity in IA (vorticityavg-IA) were significantly associated with the AWE patterns. Ordinal regression analysis identified WSSavg-IA (p=0.002) and vorticityavg-IA (p=0.033) as independent predictors of AWE patterns. CONCLUSION A low WSS and low average vorticity were independently associated with a high AWE grade for IAs larger than 4 mm. Therefore, WSS and average vorticity could predict AWE and circumferential AWE.
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Affiliation(s)
- Miaoqi Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Xin Feng
- Department of Neurosurgery, Beijing Hospital, Beijing, China
| | - Yunduo Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Baorui Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Guangrong Song
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Youxiang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Peng Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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19
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Zhang M, Peng F, Li Y, He L, Liu A, Li R. Associations between morphology and hemodynamics of intracranial aneurysms based on 4D flow and black-blood magnetic resonance imaging. Quant Imaging Med Surg 2021; 11:597-607. [PMID: 33532260 DOI: 10.21037/qims-20-440] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Previous studies have hypothesized that intracranial aneurysm (IA) morphology interacts with hemodynamic conditions. Magnetic resonance imaging (MRI) provides a single image modality solution for both morphological and hemodynamic measurements for IA. This study aimed to explore the interaction between the morphology and hemodynamics of IA using black-blood MRI (BB-MRI) and 4D flow MRI. Methods A total of 97 patients with unruptured IA were recruited for this study. The IA size, size ratio (SR), and minimum wall thickness (mWT) were measured using BB-MRI. Velocity, blood flow, pulsatility index (PI), and wall shear stress (WSS) were measured with 4D flow MRI. The relationship between hemodynamic parameters and morphological indices was investigated by linear regression analysis and unpaired two-sample t-test. To determine the independent interaction, multiple linear regression analysis was further performed. Results The findings showed that mWT was negatively correlated with IA size (r=-0.665, P<0.001). Maximum blood flow in IA (FlowIA) was positively correlated with IA size (r=0.458, P<0.001). The average WSS (WSSavg) was negatively correlated with IA size (r=-0.650, P<0.001). The relationships remained the same after the multivariate analysis was adjusted for hemodynamic, morphologic, and demographic confounding factors. The WSSavg was positively correlated with mWT (r=0.528, P<0.001). In the unpaired two-sample t-test, mWT, WSSavg, and FlowIA were statistically significantly associated with the size and SR of IAs. Conclusions There is potential for BB-MRI and 4D flow MRI to provide morphological and hemodynamic information regarding IA. Blood flow, WSS, and mWT may serve as non-invasive biomarkers for IA assessments, and may contribute to a more comprehensive understanding of the mechanism of IA.
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Affiliation(s)
- Miaoqi Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yunduo Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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20
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Le TB. Dynamic modes of inflow jet in brain aneurysms. J Biomech 2021; 116:110238. [PMID: 33485144 DOI: 10.1016/j.jbiomech.2021.110238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 01/27/2023]
Abstract
The transition of the inflow jet to turbulence is crucial in understanding the pathology of brain aneurysms. Previous works Le et al. (2010, 2013) have shown evidence for a highly dynamic inflow jet in the ostium of brain aneurysms. While it is highly desired to investigate this inflow jet dynamics in clinical practice, the constraints on spatial and temporal resolutions of in vivo data do not allow a detailed analysis of this transition. In this work, Dynamic Mode Decomposition (DMD) is used to identify the most energetic modes of the inflow jet in patient-specific models of internal carotid aneurysms via the utilization of high-resolution simulation data. It is hypothesized that dynamic modes are not solely controlled by the blood flow waveform at the parent artery. They are also dependent on jet-wall interaction phenomena. DMD analysis shows that the spatial extent of low- frequency modes corresponds well to the most energetic areas of the inflow jet. The high-frequency modes are short-lived and correspond to the flow separation at the proximal neck and the jet's impingement onto the aneurysmal wall. Low-frequency modes can be reconstructed at relatively low spatial and temporal resolutions comparable to ones of in vivo data. The current results suggest that DMD can be practically useful in analyzing blood flow patterns of brain aneurysms with in vivo data.
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Affiliation(s)
- Trung Bao Le
- Department of Civil and Environmental Engineering, North Dakota State University, CIE 201, 1410 North 14th Avenue, Fargo, ND 58105-5285, United States; NDSU-UND Biomedical Engineering Program, United States; Center for Cellular Biointerfaces in Science and Engineering, United States.
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21
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Settecase F, Rayz VL. Advanced vascular imaging techniques. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:81-105. [DOI: 10.1016/b978-0-444-64034-5.00016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Youn SW, Lee J. From 2D to 4D Phase-Contrast MRI in the Neurovascular System: Will It Be a Quantum Jump or a Fancy Decoration? J Magn Reson Imaging 2020; 55:347-372. [PMID: 33236488 DOI: 10.1002/jmri.27430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Considering the crosstalk between the flow and vessel wall, hemodynamic assessment of the neurovascular system may offer a well-integrated solution for both diagnosis and management by adding prognostic significance to the standard CT/MR angiography. 4D flow MRI or time-resolved 3D velocity-encoded phase-contrast MRI has long been promising for the hemodynamic evaluation of the great vessels, but challenged in clinical studies for assessing intracranial vessels with small diameter due to long scan times and low spatiotemporal resolution. Current accelerated MRI techniques, including parallel imaging with compressed sensing and radial k-space undersampling acquisitions, have decreased scan times dramatically while preserving spatial resolution. 4D flow MRI visualized and measured 3D complex flow of neurovascular diseases such as aneurysm, arteriovenous shunts, and atherosclerotic stenosis using parameters including flow volume, velocity vector, pressure gradients, and wall shear stress. In addition to the noninvasiveness of the phase contrast technique and retrospective flow measurement through the wanted windows of the analysis plane, 4D flow MRI has shown several advantages over Doppler ultrasound or computational fluid dynamics. The evaluation of the flow status and vessel wall can be performed simultaneously in the same imaging modality. This article is an overview of the recent advances in neurovascular 4D flow MRI techniques and their potential clinical applications in neurovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sung Won Youn
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology and Biomedical Engineering, Kyungpook National University School of Medicine, Daegu, Korea
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23
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Medero R, Ruedinger K, Rutkowski D, Johnson K, Roldán-Alzate A. In Vitro Assessment of Flow Variability in an Intracranial Aneurysm Model Using 4D Flow MRI and Tomographic PIV. Ann Biomed Eng 2020; 48:2484-2493. [PMID: 32524379 PMCID: PMC7821079 DOI: 10.1007/s10439-020-02543-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/01/2020] [Indexed: 01/10/2023]
Abstract
Aneurysm rupture has been suggested to be related to aneurysm geometry, morphology, and complex flow activity; therefore, understanding aneurysm-specific hemodynamics is crucial. 4D Flow MRI has been shown to be a feasible tool for assessing hemodynamics in intracranial aneurysms with high spatial resolution. However, it requires averaging over multiple heartbeats and cannot account for cycle-to-cycle hemodynamics variations. This study aimed to assess cycle-to-cycle flow dynamics variations in a patient-specific intracranial aneurysm model using tomographic particle image velocimetry (tomo-PIV) at a high image rate under pulsatile flow conditions. Time-resolved and time-averaged velocity flow fields within the aneurysm sac and estimations of wall shear stress (WSS) were compared with those from 4D Flow MRI. A one-way ANOVA showed a significant difference between cardiac cycles (p value < 0.0001); however, differences were not significant after PIV temporal and spatial resolution was matched to that of MRI (p value 0.9727). This comparison showed the spatial resolution to be the main contributor to assess cycle-to-cycle variability. Furthermore, the comparison with 4D Flow MRI between velocity components, streamlines, and estimated WSS showed good qualitative and quantitative agreement. This study showed the feasibility of patient-specific in-vitro experiments using tomo-PIV to assess 4D Flow MRI with high repeatability in the measurements.
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Affiliation(s)
- Rafael Medero
- Department of Mechanical Engineering, University of Wisconsin-Madison,Department of Radiology, University of Wisconsin-Madison
| | - Katrina Ruedinger
- Department of Biomedical Engineering, University of Wisconsin-Madison,School of Medicine and Public Health, University of Wisconsin-Madison
| | - David Rutkowski
- Department of Mechanical Engineering, University of Wisconsin-Madison,Department of Radiology, University of Wisconsin-Madison
| | - Kevin Johnson
- Department of Medical Physics, University of Wisconsin-Madison
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison,Department of Radiology, University of Wisconsin-Madison,Department of Biomedical Engineering, University of Wisconsin-Madison
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24
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Castle-Kirszbaum M, Maingard J, Lim RP, Barras CD, Kok HK, Chandra RV, Chong W, Asadi H. Four-Dimensional Magnetic Resonance Imaging Assessment of Intracranial Aneurysms: A State-of-the-Art Review. Neurosurgery 2020; 87:453-465. [PMID: 32140714 DOI: 10.1093/neuros/nyaa021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/15/2019] [Indexed: 11/14/2022] Open
Abstract
Treatment of unruptured intracranial aneurysms can reduce the risk of subarachnoid hemorrhage and its associated morbidity and mortality. However, current methods to predict the risk of rupture and optimize treatment strategies for intracranial aneurysms are limited. Assessment of intra-aneurysmal flow using 4-dimensional magnetic resonance imaging (4D MRI) is a novel tool that could be used to guide therapy. A systematic search of the literature was performed to provide a state-of-the-art review on 4D MRI assessment of unruptured intracranial aneurysms. A total of 18 studies were available for review. Eccentric flow on 4D MRI is associated with a greater aspect ratio and peak wall shear stress (WSS). WSS, vorticity, and peak velocity are greater in saccular than fusiform aneurysms. Unstable aneurysms are associated with greater WSS, peak wall stress, and flow jet angle and may exhibit wall enhancement. In comparison to computational fluid dynamics (CFD), 4D MRI has a lower spatial resolution and reports lower WSS and velocity magnitudes, but these parameters equalize when spatial resolution is matched. 4D MRI demonstrates the intra-aneurysmal hemodynamic changes associated with flow diversion, including significantly decreased flow velocity. Thus, 4D MRI is a novel, noninvasive imaging tool used for the evaluation of hemodynamics within intracranial aneurysms. Hemodynamic indices derived from 4D MRI appear to correlate well with the simulated (CFD) values and may be used to measure the success of endovascular therapies and risk factors for aneurysm growth and rupture.
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Affiliation(s)
- Mendel Castle-Kirszbaum
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Julian Maingard
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,School of Medicine, Deakin University, Victoria, Australia
| | - Ruth P Lim
- Austin Health, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Christen D Barras
- Department of Radiology, Royal Adelaide Hospital, The University of Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Hong Kuan Kok
- School of Medicine, Deakin University, Victoria, Australia.,Department of Radiology Northern Health, Melbourne, Australia
| | - Ronil V Chandra
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Winston Chong
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Australia.,Department of Imaging, Monash Health, Melbourne, Australia.,School of Medicine, Deakin University, Victoria, Australia.,Austin Health, Melbourne, Australia
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25
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Leemans EL, Cornelissen BMW, Said M, van den Berg R, Slump CH, Marquering HA, Majoie CBLM. Intracranial aneurysm growth: consistency of morphological changes. Neurosurg Focus 2020; 47:E5. [PMID: 31261128 DOI: 10.3171/2019.4.focus1987] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have shown a relation between growth and rupture of intracranial aneurysms. Additionally, several morphological characteristics are frequently measured to estimate rupture risk. Little is known about how the rupture risk is associated with morphological characteristic changes during growth. The aim of this study was to provide insights into how morphological characteristics, associated with rupture, change during an aneurysm's growth. METHODS The authors retrospectively identified patients with longitudinal MRA images of unruptured growing aneurysms. The MRA images had an in-plane resolution of 0.2-0.5 mm and a slice thickness of 0.2-0.75 mm. Therefore, growth was defined as an increase of at least 0.5 mm in two directions or 1 mm in one direction. Using the MRA images, the authors semiautomatically segmented the aneurysm and the perianeurysmal vasculature. Twelve morphological characteristics were automatically measured. These characteristics were related to size (diameter, height, width, neck diameter, volume, surface area, aspect ratio, height-width ratio, and bottleneck factor) and shape (ellipticity index, nonsphericity index, and undulation index) of the aneurysm. Morphological characteristics before and after growth were compared using the Wilcoxon signed-rank test. RESULTS The authors included 31 patients with 38 growing aneurysms. The aneurysms' growth was detected after a mean of 218 weeks (range 23-567 weeks). A significant increase was seen in all size-related characteristics, and the bottleneck factor also significantly increased (from a median of 1.00 [IQR 0.85-1.04] to 1.03 [IQR 0.93-1.18]), while the ellipticity index decreased (from a median of 0.26 [IQR 0.25-0.28] to 0.25 [IQR 0.24-0.26]). The changes in size ratios and shape indices varied largely among patients. Larger aneurysms more often showed an increase in shape ratios. CONCLUSIONS Although aneurysm growth, size-related characteristics, bottleneck factor, and ellipticity index changed significantly during growth, most size ratios and shape indices showed inconsistent changes among aneurysms. This suggests that, for an accurate rupture prediction, morphological parameters need to be reassessed after growth.
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Affiliation(s)
- Eva L Leemans
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Bart M W Cornelissen
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and.,3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Miran Said
- Departments of1Biomedical Engineering and Physics, and
| | - René van den Berg
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Cornelis H Slump
- 3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Henk A Marquering
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Charles B L M Majoie
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
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26
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Abstract
Magnetic resonance imaging (MRI) has become an important tool for the clinical evaluation of patients with cardiac and vascular diseases. Since its introduction in the late 1980s, quantitative flow imaging with MRI has become a routine part of standard-of-care cardiothoracic and vascular MRI for the assessment of pathological changes in blood flow in patients with cardiovascular disease. More recently, time-resolved flow imaging with velocity encoding along all three flow directions and three-dimensional (3D) anatomic coverage (4D flow MRI) has been developed and applied to enable comprehensive 3D visualization and quantification of hemodynamics throughout the human circulatory system. This article provides an overview of the use of 4D flow applications in different cardiac and vascular regions in the human circulatory system, with a focus on using 4D flow MRI in cardiothoracic and cerebrovascular diseases.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois 60208, USA
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27
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Saqr KM, Rashad S, Tupin S, Niizuma K, Hassan T, Tominaga T, Ohta M. What does computational fluid dynamics tell us about intracranial aneurysms? A meta-analysis and critical review. J Cereb Blood Flow Metab 2020; 40:1021-1039. [PMID: 31213162 PMCID: PMC7181089 DOI: 10.1177/0271678x19854640] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the plethora of published studies on intracranial aneurysms (IAs) hemodynamic using computational fluid dynamics (CFD), limited progress has been made towards understanding the complex physics and biology underlying IA pathophysiology. Guided by 1733 published papers, we review and discuss the contemporary IA hemodynamics paradigm established through two decades of IA CFD simulations. We have traced the historical origins of simplified CFD models which impede the progress of comprehending IA pathology. We also delve into the debate concerning the Newtonian fluid assumption used to represent blood flow computationally. We evidently demonstrate that the Newtonian assumption, used in almost 90% of studies, might be insufficient to describe IA hemodynamics. In addition, some fundamental properties of the Navier-Stokes equation are revisited in supplementary material to highlight some widely spread misconceptions regarding wall shear stress (WSS) and its derivatives. Conclusively, our study draws a roadmap for next-generation IA CFD models to help researchers investigate the pathophysiology of IAs.
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Affiliation(s)
- Khalid M Saqr
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,Department of Mechanical Engineering, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
| | - Sherif Rashad
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Simon Tupin
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
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28
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Rayz VL, Cohen-Gadol AA. Hemodynamics of Cerebral Aneurysms: Connecting Medical Imaging and Biomechanical Analysis. Annu Rev Biomed Eng 2020; 22:231-256. [PMID: 32212833 DOI: 10.1146/annurev-bioeng-092419-061429] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the last two decades, numerous studies have conducted patient-specific computations of blood flow dynamics in cerebral aneurysms and reported correlations between various hemodynamic metrics and aneurysmal disease progression or treatment outcomes. Nevertheless, intra-aneurysmal flow analysis has not been adopted in current clinical practice, and hemodynamic factors usually are not considered in clinical decision making. This review presents the state of the art in cerebral aneurysm imaging and image-based modeling, discussing the advantages and limitations of each approach and focusing on the translational value of hemodynamic analysis. Combining imaging and modeling data obtained from different flow modalities can improve the accuracy and fidelity of resulting velocity fields and flow-derived factors that are thought to affect aneurysmal disease progression. It is expected that predictive models utilizing hemodynamic factors in combination with patient medical history and morphological data will outperform current risk scores and treatment guidelines. Possible future directions include novel approaches enabling data assimilation and multimodality analysis of cerebral aneurysm hemodynamics.
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Affiliation(s)
- Vitaliy L Rayz
- Weldon School of Biomedical Engineering and School of Mechanical Engineering, Purdue University, West Lafayette, Indiana 47907, USA;
| | - Aaron A Cohen-Gadol
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.,Goodman Campbell Brain and Spine, Carmel, Indiana 46032, USA
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29
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Schmitter S, Adriany G, Waks M, Moeller S, Aristova M, Vali A, Auerbach EJ, Van de Moortele PF, Ugurbil K, Schnell S. Bilateral Multiband 4D Flow MRI of the Carotid Arteries at 7T. Magn Reson Med 2020; 84:1947-1960. [PMID: 32187742 DOI: 10.1002/mrm.28256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Simultaneous multislab (SMSb) 4D flow MRI was developed and implemented at 7T for accelerated acquisition of the 3D blood velocity vector field in both carotid bifurcations. METHODS SMSb was applied to 4D flow to acquire blood velocities in both carotid bifurcations in sagittal orientation using a local transmit/receive coil at 7T. B 1 + transmit efficiency was optimized by B 1 + shimming. SMSb 4D flow was obtained in 8 healthy subjects in single-band (SB) and multiband (MB) fashion. Additionally, MB data were retrospectively undersampled to simulate GRAPPA R = 2 (MB2_GRAPPA2), and both SB datasets were added to form an artificial MB dataset (SumSB). The band separation performance was quantified by signal leakage. Peak velocity and total flow values were calculated and compared to SB via intraclass correlation analysis (ICC). RESULTS Clean slab separation was achieved yielding a mean signal leakage of 13% above the mean SB noise level. Mean total flow for MB2, SumSB, and MB_GRAPPA2 deviated less than 9% from the SB values. Peak velocities averaged over all vessels and subjects were 0.48 ± 0.11 m/s for SB, 0.47 ± 0.12 m/s for SumSB, 0.50 ± 0.13 m/s for MB2, and 0.53 ± 0.13 m/s for MB2_GRAPPA2. ICC revealed excellent absolute agreement and consistency of total flow for all methods compared to SB2. Peak velocity showed good to excellent agreement and consistency for SumSB and MB2 and MB2_GRAPPA2 method showed poor to excellent agreement and good to excellent consistency. CONCLUSION Simultaneous multislab 4D Flow MRI allows accurate quantification of total flow and peak velocity while reducing scan times.
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Affiliation(s)
- Sebastian Schmitter
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.,Physikalisch-Technische Bundesanstalt, Braunschweig and Berlin, Germany
| | - Gregor Adriany
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Matt Waks
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Steen Moeller
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Maria Aristova
- McCormick School of Engineering, Northwestern University, Evanston, USA.,Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Alireza Vali
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Edward J Auerbach
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | | | - Kamil Ugurbil
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Susanne Schnell
- Feinberg School of Medicine, Northwestern University, Chicago, USA
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30
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Wink C, Bassenge JP, Ferrazzi G, Schaeffter T, Schmitter S. 4D flow imaging with UNFOLD in a reduced FOV. Magn Reson Med 2019; 84:327-338. [PMID: 31873954 DOI: 10.1002/mrm.28120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE Two-dimensional selective excitation (2DRF) allows shortening 4D flow scan times by reducing the FOV, but the longer 2DRF pulse duration decreases the temporal resolution, yielding underestimated peak flow values. Multiple k-space lines per cardiac phase, nl ≥ 2, are commonly applied in 4D flow MRI to shorten the inherent long scan times. We demonstrate that 2DRF 4D flow with nl ≥ 2 can be easily combined with UNFOLD (UNaliasing by Fourier-encoding the Overlaps using the temporaL Dimension), a technique that allows regaining nominally the temporal resolution of the respective acquisition with nl = 1, to assure peak flow quantification. METHODS Two different 2DRF pulses with spiral k-space trajectories were designed and integrated into a 4D flow sequence. Flow phantom experiments and 7 healthy control 4D flow in vivo measurements, with and without UNFOLD reconstructions, were compared with conventional reconstruction and 1D slab-selective excitation (1DRF) by evaluating time-resolved flow curves, peak flow, peak velocity, blood flow volume per cardiac cycle, and spatial aliasing. RESULTS Applying UNFOLD to 4D flow imaging with 2DRF and reduced FOV increased the quantified in vivo peak flow values significantly by 3.7% ± 2.3% to 5.2% ± 2.4% (P < .05). Accordingly, the peak flow underestimation of 2DRF scans compared with conventional 1DRF scans decreased with UNFOLD. Finally, 2DRF combined with UNFOLD accelerated the 4D flow acquisition 3.5 ± 1.4 fold by reducing the FOV and increasing the effective temporal resolution by 6.7% compared with conventional 1D selective excitation, with 2 k-space lines per cardiac phase. CONCLUSION Two-dimensional selective excitation combined with UNFOLD allows limiting the FOV to shorten 4D flow scan times and compensates for the loss in temporal resolution with 2DRF (Δt = 64.8 ms) compared with 1DRF (Δt = 43.2 ms), yielding an effective resolution of Δteff = 40.5 ms to enhance peak flow quantification.
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Affiliation(s)
- Clarissa Wink
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,FG Medizintechnik, Technische Universität Berlin, Berlin, Germany
| | - Jean Pierre Bassenge
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Giulio Ferrazzi
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,FG Medizintechnik, Technische Universität Berlin, Berlin, Germany
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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31
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Gareev IF, Safin SM. [The role of endogenous miRNAs in the development of cerebral aneurysms]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:112-118. [PMID: 30900695 DOI: 10.17116/neiro201983011112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cerebral aneurysms are characterized by pathological expansion and thinning of the wall of vessels on the brain base, which may lead to rupture and subarachnoid hemorrhage (SAH) that is a life-threatening condition. This dictates the need for identification of new biological markers that predict the presence of aneurysms and the risk of their rupture. In the last decade, the role of microRNAs (miRNAs), which are considered to be key regulators of biological processes, has been investigated. miRNAs have been shown to play a role in the development of aneurysms, but today there is little similar data. In this literature review, we analyze the existing data on the role of miRNAs in development, progression, and rupture of cerebral aneurysms. We describe the relationship between miRNA expression profiles and specific molecular and cellular processes leading to the development of aneurysms. Also, we discuss the potential clinical significance of miRNAs for predicting the risk of aneurysm rupture.
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Affiliation(s)
- I F Gareev
- Bashkir State Medical University, Ufa, Russia
| | - Sh M Safin
- Bashkir State Medical University, Ufa, Russia
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32
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Barletta EA, Gaspar RHML, Araújo JFM, Neves MWF, de Aquino JLB, Belsuzarri TAB. Nonsaccular aneurysms: A wide comparison between the four main types. Surg Neurol Int 2019; 10:30. [PMID: 31528368 PMCID: PMC6499464 DOI: 10.4103/sni.sni_138_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Abstract
Background: The present study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, morphology, pathogenesis, and the best treatment for each type of the nonsaccular aneurysms. Methods: We performed a literature review using PubMed. The search was limited to the studies published in English, from 2010 to 2017. Results: Data about the clinical presentation; the aneurysm pathogenesis, morphology, and localization; the patient features; and about the surgical or endovascular approach were analyzed for the four types of nonsaccular aneurysms presented. Conclusion: All types of nonsaccular aneurysms have a higher prevalence in young adults. Men are more affected by fusiform and mycotic aneurysms while women suffer more with blister-like aneurysms (BLAs). The mycotic and the BLAs affect more the anterior circulation while the fusiform affects more the posterior circulation. Mycotic and blister-like has as its major complication and clinical presentation the hemorrhage; however, the fusiform aneurysms usually present ischemia and/or mass effect. The reconstructive endovascular techniques for all types of nonsaccular aneurysms presented as the treatment with the best outcomes. Among this technique, the flow diversion presented good results in all types of aneurysms and it seems to promote the best outcomes.
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Affiliation(s)
| | | | | | | | | | - Telmo Augusto Barba Belsuzarri
- Medicine Student from Pontifical Catholic University of Campinas, Campinas, SP, Brazil.,Neurosurgery Department from Pontifical Catholic University of Campinas, Campinas, SP, Brazil.,Post-Graduation Department at Pontifical Catholic University of Campinas, Campinas, SP, Brazil
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33
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Reconstructing patient-specific cerebral aneurysm vasculature for in vitro investigations and treatment efficacy assessments. J Clin Neurosci 2018; 61:153-159. [PMID: 30470652 DOI: 10.1016/j.jocn.2018.10.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/27/2018] [Indexed: 11/27/2022]
Abstract
Perianeurysmal hemodynamics play a vital role in the initiation, growth and rupture of intracranial aneurysms. In vitro investigations of aneurysmal hemodynamics are helpful to visualize and measure blood flow, and aiding surgical planning approaches. Improving in vitro model creation can improve the feasibility and accuracy of hemodynamic investigations and surgical planning, improving clinical value. In this study, in vitro models were created from three-dimensional rotational angiography (3DRA) of six patients harboring intracranial aneurysms using a multi-step process involving 3D printing, index of refraction matching and silicone casting that renders the models transparent for flow visualization. Each model was treated with the same commercially-available, patient-specific, endovascular devices (coils and/or stents). All models were scanned by synchrotron X-ray microtomography to obtain high-resolution imaging of the vessel lumen, aneurysmal sac and endovascular devices. Dimensional accuracy was compared by quantifying the differences between the microtomographic reconstructions of the fabricated phantoms and the original 3DRA obtained during patient treatment. True-scale in vitro flow phantoms were successfully created for all six patients. Optical transparency was verified by using an index of refraction matched working fluid that replicated the mechanical behavior of blood. Synchrotron imaging of vessel lumen, aneurysmal sac and endovascular devices was successfully obtained, and dimensional errors were found to be O(100 μm). The creation of dimensionally-accurate, optically-transparent flow phantoms of patient-specific intracranial aneurysms is feasible using 3D printing technology. Such models may enable in vitro investigations of aneurysmal hemodynamics to aid in treatment planning and outcome prediction to devise optimal patient-specific neurointerventional strategies.
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34
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Zhang Y, Ma C, Liang S, Yan P, Liang F, Guo F, Jiang C. Morphologic Feature Elongation Can Predict Occlusion Status Following Pipeline Embolization of Intracranial Aneurysms. World Neurosurg 2018; 119:e934-e940. [DOI: 10.1016/j.wneu.2018.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022]
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35
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Barletta EA, Ricci RL, Silva RDG, Gaspar RHML, Araújo JFM, Neves MWF, de Aquino JLB, Barba Belsuzarri TA. Fusiform aneurysms: A review from its pathogenesis to treatment options. Surg Neurol Int 2018; 9:189. [PMID: 30294493 PMCID: PMC6169346 DOI: 10.4103/sni.sni_133_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/09/2018] [Indexed: 12/23/2022] Open
Abstract
Background This study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, and morphology of the aneurysm and the treatments outcomes of the fusiform aneurysms. Methods We performed a literature review using PubMed. The search was limited to the studies published in English, from 2003 to 2017. Results The studies analyzed that showed data about the patient features, clinical presentation, the aneurysm localization, morphology, and pathogenesis didn't present much divergence. The surgical and the endovascular approach showed similar treatments outcomes. The reconstructive techniques seem to be safer than the deconstructive. The flow diversion is a technique that showed great results. Conclusion Most of the patients are men, younger than 50 years old, pediatric patients are the most affected. Surgical procedures still have an important place in this field. Reconstructive and deconstructive techniques are both effective; the reconstructive techniques are possibly safer than deconstructive techniques. The most important feature of an aneurysm to predict a bad prognose is to determine if the aneurysm is ruptured. The reconstructive EVT accompanied by dual antiplatelet after and before the procedure showed the best results to treat the basilar fusiform aneurysms. Deconstructive treatment including posterior inferior cerebellar artery occlusion should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | - Telmo Augusto Barba Belsuzarri
- Department of Neurosurgery from Pontifical Catholic University of Campinas, Brazil.,Post Graduation at the State Server Hospital (IAMSPE), Brazil.,Post Graduation Program, Masters in Health Sciences, Pontifical Catholic University of Campinas, Brazil
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36
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Medero R, Hoffman C, Roldán-Alzate A. Comparison of 4D Flow MRI and Particle Image Velocimetry Using an In Vitro Carotid Bifurcation Model. Ann Biomed Eng 2018; 46:2112-2122. [PMID: 30112708 DOI: 10.1007/s10439-018-02109-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/27/2018] [Indexed: 01/13/2023]
Abstract
Four-dimensional (4D) Flow magnetic resonance imaging (MRI) enables the acquisition and assessment of complex hemodynamics in vivo from different vascular territories. This study investigated the viability of stereoscopic and tomographic particle image velocimetry (stereo- and tomo-PIV, respectively) as experimental validation techniques for 4D Flow MRI. The experiments were performed using continuous and pulsatile flows through an idealized carotid artery bifurcation model. Transverse and longitudinal planes were extracted from the acquired velocity data sets at different regions of interest and were analyzed with a point-by-point comparison. An overall root-mean-square error (RMSE) was calculated resulting in errors as low as 0.06 and 0.03 m/s when comparing 4D Flow MRI with stereo- and tomo-PIV, respectively. Quantitative agreement between techniques was determined by evaluating the relationship for individual velocity components and their magnitudes. These resulted in correlation coefficients (R2) of 4D Flow MRI with stereo- and tomo-PIV, as low as 0.76 and 0.73, respectively. The 3D velocity measurements from PIV showed qualitative agreement when compared to 4D Flow MRI, especially with tomo-PIV due to the addition of volumetric velocity measurements. These results suggest that tomo-PIV can be used as a validation technique for 4D Flow MRI, serving as the basis for future validation protocols.
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Affiliation(s)
- Rafael Medero
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA. .,, 1415 Engineering Drive, Madison, WI, 53706, USA.
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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37
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Hemodynamics in a giant intracranial aneurysm characterized by in vitro 4D flow MRI. PLoS One 2018; 13:e0188323. [PMID: 29300738 PMCID: PMC5754057 DOI: 10.1371/journal.pone.0188323] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Abstract
Experimental and computational data suggest that hemodynamics play a critical role in the development, growth, and rupture of cerebral aneurysms. The flow structure, especially in aneurysms with a large sac, is highly complex and three-dimensional. Therefore, volumetric and time-resolved measurements of the flow properties are crucial to fully characterize the hemodynamics. In this study, phase-contrast Magnetic Resonance Imaging is used to assess the fluid dynamics inside a 3D-printed replica of a giant intracranial aneurysm, whose hemodynamics was previously simulated by multiple research groups. The physiological inflow waveform is imposed in a flow circuit with realistic cardiovascular impedance. Measurements are acquired with sub-millimeter spatial resolution for 16 time steps over a cardiac cycle, allowing for the detailed reconstruction of the flow evolution. Moreover, the three-dimensional and time-resolved pressure distribution is calculated from the velocity field by integrating the fluid dynamics equations, and is validated against differential pressure measurements using precision transducers. The flow structure is characterized by vortical motions that persist within the aneurysm sac for most of the cardiac cycle. All the main flow statistics including velocity, vorticity, pressure, and wall shear stress suggest that the flow pattern is dictated by the aneurysm morphology and is largely independent of the pulsatility of the inflow, at least for the flow regimes investigated here. Comparisons are carried out with previous computational simulations that used the same geometry and inflow conditions, both in terms of cycle-averaged and systolic quantities.
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38
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Ota H, Higuchi S, Sun W, Ueda T, Takase K, Tamura H. Four-Dimensional Flow Magnetic Resonance Imaging for Cardiovascular Imaging: from Basic Concept to Clinical Application. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Wenyu Sun
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Takuya Ueda
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hajime Tamura
- Division of Medical Physics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Longo M, Granata F, Racchiusa S, Mormina E, Grasso G, Longo GM, Garufi G, Salpietro FM, Alafaci C. Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario. World Neurosurg 2017; 105:632-642. [DOI: 10.1016/j.wneu.2017.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/16/2022]
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40
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Garcia J, van der Palen RLF, Bollache E, Jarvis K, Rose MJ, Barker AJ, Collins JD, Carr JC, Robinson J, Rigsby CK, Markl M. Distribution of blood flow velocity in the normal aorta: Effect of age and gender. J Magn Reson Imaging 2017; 47:487-498. [PMID: 28556277 DOI: 10.1002/jmri.25773] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/10/2017] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To apply flow distribution analysis in the entire aorta across a wide age range from pediatric to adult subjects. MATERIAL AND METHODS In all, 98 healthy subjects (age 9-78 years, 41 women) underwent 4D flow MRI at 1.5T and 3T for the assessment of 3D blood flow in the thoracic aorta. Subjects were categorized into age groups: group 1 (n = 9, 5 women): 9-15 years; group 2 (n = 13, 8 women): 16-20 years; group 3 (n = 27, 14 women): 21-39 years; group 4 (n = 40, 11 women): 40-59 years; group 5 (n = 9, 3 women): >60 years. Data analysis included the 3D segmentation of the aorta, aortic valve peak velocity, mid-ascending aortic diameter, and calculation of flow velocity distribution descriptors (mean, median, standard deviation, incidence of velocities >1 m/s, skewness, and kurtosis of aortic velocity magnitude). Ascending aortic diameter was normalized by body surface area. RESULTS Age was significantly associated with normalized aortic diameter (R = 0.73, P < 0.001), skewness (R = 0.76, P < 0.001), and kurtosis (R = 0.74, P < 0.001), all adjusted by heart rate. Aortic peak velocity and velocity distribution descriptors, adjusted by heart rate, were significantly different between age groups (P < 0.001, analysis of covariance). Skewness and kurtosis significantly increased (P < 0.001) during adulthood (>40 years) as compared with childhood (<21 years). Men and women revealed significant differences (P ≤ 0.05) for peak velocity, incidence, mean, median, standard deviation, and skewness, all adjusted by heart rate. CONCLUSION Aortic hemodynamics significantly change with age and gender, indicating the importance of age- and gender-matched control cohorts for the assessment of the impact of cardiovascular disease on aortic blood flow. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:487-498.
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Affiliation(s)
- Julio Garcia
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Emilie Bollache
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Michael J Rose
- Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Association between hemodynamics, morphology, and rupture risk of intracranial aneurysms: a computational fluid modeling study. Neurol Sci 2017; 38:1009-1018. [PMID: 28285454 PMCID: PMC5486504 DOI: 10.1007/s10072-017-2904-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/07/2017] [Indexed: 12/22/2022]
Abstract
The objective of the study was to examine the correlations between intracranial aneurysm morphology and wall shear stress (WSS) to identify reliable predictors of rupture risk. Seventy-two intracranial aneurysms (41 ruptured and 31 unruptured) from 63 patients were studied retrospectively. All aneurysms were divided into two categories: narrow (aspect ratio ≥1.4) and wide-necked (aspect ratio <1.4 or neck width ≥4 mm). Computational fluid dynamics was used to determine the distribution of WSS, which was analyzed between different morphological groups and between ruptured and unruptured aneurysms. Sections of the walls of clipped aneurysms were stained with hematoxylin–eosin, observed under a microscope, and photographed. Ruptured aneurysms were statistically more likely to have a greater low WSS area ratio (LSAR) (P = 0.001) and higher aneurysms parent WSS ratio (P = 0.026) than unruptured aneurysms. Narrow-necked aneurysms were statistically more likely to have a larger LSAR (P < 0.001) and lower values of MWSS (P < 0.001), mean aneurysm-parent WSS ratio (P < 0.001), HWSS (P = 0.012), and the highest aneurysm-parent WSS ratio (P < 0.001) than wide-necked aneurysms. The aneurysm wall showed two different pathological changes associated with high or low WSS in wide-necked aneurysms. Aneurysm morphology could affect the distribution and magnitude of WSS on the basis of differences in blood flow. Both high and low WSS could contribute to focal wall damage and rupture through different mechanisms associated with each morphological type.
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42
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Lawley CM, Broadhouse KM, Callaghan FM, Winlaw DS, Figtree GA, Grieve SM. 4D flow magnetic resonance imaging: role in pediatric congenital heart disease. Asian Cardiovasc Thorac Ann 2017; 26:28-37. [PMID: 28185475 DOI: 10.1177/0218492317694248] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Imaging-based evaluation of cardiac structure and function remains paramount in the diagnosis and monitoring of congenital heart disease in childhood. Accurate measurements of intra- and extracardiac hemodynamics are required to inform decision making, allowing planned timing of interventions prior to deterioration of cardiac function. Four-dimensional flow magnetic resonance imaging is a nonionizing noninvasive technology that allows accurate and reproducible delineation of blood flow at any anatomical location within the imaging volume of interest, and also permits derivation of physiological parameters such as kinetic energy and wall shear stress. Four-dimensional flow is the focus of a great deal of attention in adult medicine, however, the translation of this imaging technique into the pediatric population has been limited to date. A more broad-scaled application of 4-dimensional flow in pediatric congenital heart disease stands to increase our fundamental understanding of the cause and significance of abnormal blood flow patterns, may improve risk stratification, and inform the design and use of surgical and percutaneous correction techniques. This paper seeks to outline the application of 4-dimensional flow in the assessment and management of the pediatric population affected by congenital heart disease.
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Affiliation(s)
- Claire M Lawley
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia.,3 Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Kathryn M Broadhouse
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Fraser M Callaghan
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - David S Winlaw
- 4 Heart Centre for Children & University of Sydney, The Children's Hospital at Westmead, Sydney, Australia
| | - Gemma A Figtree
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia
| | - Stuart M Grieve
- 1 Sydney Translational Imaging Laboratory, Sydney Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia.,2 North Shore Heart Research Group, Kolling Institute of Medical Research, Sydney Medical School Northern, University of Sydney, Sydney, Australia.,5 Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia
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43
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Schnell S, Ansari SA, Wu C, Garcia J, Murphy IG, Rahman OA, Rahsepar AA, Aristova M, Collins JD, Carr JC, Markl M. Accelerated dual-venc 4D flow MRI for neurovascular applications. J Magn Reson Imaging 2017; 46:102-114. [PMID: 28152256 DOI: 10.1002/jmri.25595] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To improve velocity-to-noise ratio (VNR) and dynamic velocity range of 4D flow magnetic resonance imaging (MRI) by using dual-velocity encoding (dual-venc) with k-t generalized autocalibrating partially parallel acquisition (GRAPPA) acceleration. MATERIALS AND METHODS A dual-venc 4D flow MRI sequence with k-t GRAPPA acceleration was developed using a shared reference scan followed by three-directional low- and high-venc scans (repetition time / echo time / flip angle = 6.1 msec / 3.4 msec / 15°, temporal/spatial resolution = 43.0 msec/1.2 × 1.2 × 1.2 mm3 ). The high-venc data were used to correct for aliasing in the low-venc data, resulting in a single dataset with the favorable VNR of the low-venc but without velocity aliasing. The sequence was validated with a 3T MRI scanner in phantom experiments and applied in 16 volunteers to investigate its feasibility for assessing intracranial hemodynamics (net flow and peak velocity) at the major intracranial vessels. In addition, image quality and image noise were assessed in the in vivo acquisitions. RESULTS All 4D flow MRI scans were acquired successfully with an acquisition time of 20 ± 4 minutes. The shared reference scan reduced the total acquisition time by 12.5% compared to two separate scans. Phantom experiments showed 51.4% reduced noise for dual-venc compared to high-venc and an excellent agreement of velocities (ρ = 0.8, P < 0.001). The volunteer data showed decreased noise in dual-venc data (54.6% lower) compared to high-venc, and improved image quality, as graded by two observers: fewer artifacts (P < 0.0001), improved vessel conspicuity (P < 0.0001), and reduced noise (P < 0.0001). CONCLUSION Dual-venc 4D flow MRI exhibits the superior VNR of the low-venc acquisition and reliably incorporates low- and high-velocity fields simultaneously. In vitro and in vivo data demonstrate improved flow visualization, image quality, and image noise. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:102-114.
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Affiliation(s)
- Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sameer A Ansari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Can Wu
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
| | - Julio Garcia
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Cardiac Sciences - Stephenson Cardiac Imaging Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ian G Murphy
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ozair A Rahman
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amir A Rahsepar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Aristova
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
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Wu C, Schnell S, Vakil P, Honarmand AR, Ansari SA, Carr J, Markl M, Prabhakaran S. In Vivo Assessment of the Impact of Regional Intracranial Atherosclerotic Lesions on Brain Arterial 3D Hemodynamics. AJNR Am J Neuroradiol 2017; 38:515-522. [PMID: 28057635 DOI: 10.3174/ajnr.a5051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/26/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis induces hemodynamic disturbance, which is not well-characterized, particularly in cerebral flow redistribution. We aimed to characterize the impact of regional stenotic lesions on intracranial hemodynamics by using 4D flow MR imaging. MATERIALS AND METHODS 4D flow MR imaging was performed in 22 symptomatic patients (mean age, 68.4 ± 14.2 years) with intracranial stenosis (ICA, n = 7; MCA, n = 9; basilar artery, n = 6) and 10 age-appropriate healthy volunteers (mean age, 60.7 ± 8.1 years). 3D blood flow patterns were visualized by using time-integrated pathlines. Blood flow and peak velocity asymmetry indices were compared between patients and healthy volunteers in 4 prespecified arteries: ICAs, MCAs, and anterior/posterior cerebral arteries. RESULTS 3D blood flow pathlines demonstrated flow redistribution across cerebral arteries in patients with unilateral intracranial stenosis. For patients with ICA stenosis compared with healthy volunteers, significantly lower flow and peak velocities were identified in the ipsilateral ICA (P = .001 and P = .001) and MCA (P < .001 and P = .001), but higher flow, in the ipsilateral PCA (P < .001). For patients with MCA stenosis, significantly lower flow and peak velocities were observed in the ipsilateral ICA (P = .009 and P = .045) and MCA (P < .001 and P = .005), but significantly higher flow was found in the ipsilateral posterior cerebral artery (P = .014) and anterior cerebral artery (P = .006). The asymmetry indices were not significantly different between patients with basilar artery stenosis and the healthy volunteers. CONCLUSIONS Regional intracranial atherosclerotic lesions not only alter distal arterial flow but also significantly affect ipsilateral collateral arterial hemodynamics.
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Affiliation(s)
- C Wu
- From the Department of Biomedical Engineering (C.W., M.M.), McCormick School of Engineering, Northwestern University, Chicago, Illinois .,Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.).,Philips Healthcare (C.W.), Gainesville, Florida
| | - S Schnell
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - P Vakil
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - A R Honarmand
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - S A Ansari
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.).,Neurological Surgery (S.A.A.)
| | - J Carr
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - M Markl
- From the Department of Biomedical Engineering (C.W., M.M.), McCormick School of Engineering, Northwestern University, Chicago, Illinois.,Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - S Prabhakaran
- Neurology (S.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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45
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Wu C, Schoeneman SE, Kuhn R, Honarmand AR, Schnell S, Ansari SA, Carr J, Markl M, Shaibani A. Complex Alterations of Intracranial 4-Dimensional Hemodynamics in Vein of Galen Aneurysmal Malformations During Staged Endovascular Embolization. Oper Neurosurg (Hagerstown) 2016; 12:239-249. [PMID: 29506111 DOI: 10.1227/neu.0000000000001137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vein of Galen aneurysmal malformations (VGAMs) are rare congenital cerebral arteriovenous shunts often treated by staged endovascular embolization early in life. Treatment-induced changes in intracranial hemodynamics and their impact on the clinical management of VGAM patients remain unclear. OBJECTIVE To evaluate hemodynamic alterations in the cerebral arterial and venous network in pediatric patients with VGAMs during staged embolizations. METHODS Serial 4-dimensional flow magnetic resonance imaging (21 scans) was performed in 6 VGAM patients (3 female; mean age, 2.1 ± 4.0 years) undergoing staged embolization. Time-integrated pathlines were used to visualize 3-dimensional blood flow changes in intracranial arterial and venous systems. Total cerebral arterial inflow (flow in bilateral internal carotid arteries plus basilar artery), arteriovenous shunt flow, and blood flow in other major cerebral arteries (middle cerebral artery; posterior cerebral artery) were quantified for all patients. RESULTS Intracranial 3-dimensional blood flow visualization demonstrated marked reduction of arteriovenous shunting and distinct hemodynamic alterations after embolization. From baseline to endpoint embolization, total cerebral arterial inflow dropped by 40.2% (from 22.70 ± 6.54 mL/s to 13.57 ± 4.87 mL/s), corresponding to arteriovenous shunt flow reduction of 73.5% (from 9.69 ± 6.16 mL/s to 2.57 ± 3.79 mL/s). In addition, the ipsilateral posterior cerebral artery/middle cerebral artery flow ratio decreased by 86.9% (from 4.20 ± 6.28 to 0.55 ± 0.23). CONCLUSION Hemodynamic alterations in VGAMs after embolization can be visualized and quantified using 4-dimensional flow magnetic resonance imaging. Cerebral arterial inflow and arteriovenous shunt flow reduction and complex flow redistribution after embolization illustrate the potential of 4-dimensional flow magnetic resonance imaging to better evaluate the efficacy of interventions and monitor treatment effects.
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Affiliation(s)
- Can Wu
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Samantha E Schoeneman
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ryan Kuhn
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Amir R Honarmand
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sameer A Ansari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ali Shaibani
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Schnell S, Wu C, Ansari SA. Four-dimensional MRI flow examinations in cerebral and extracerebral vessels - ready for clinical routine? Curr Opin Neurol 2016; 29:419-28. [PMID: 27262148 PMCID: PMC4939804 DOI: 10.1097/wco.0000000000000341] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To evaluate the feasibility of 4-dimensional (4D) flow MRI for the clinical assessment of cerebral and extracerebral vascular hemodynamics in patients with neurovascular disease. RECENT FINDINGS 4D flow MRI has been applied in multiple studies to qualitatively and quantitatively study intracranial aneurysm blood flow for potential risk stratification and to assess treatment efficacy of various neurovascular lesions, including intraaneurysmal and parent artery blood flow after flow diverter stent placement and staged embolizations of arteriovenous malformations and vein of Galen aneurysmal malformations. Recently, the technique has been utilized to characterize age-related changes of normal cerebral hemodynamics in healthy individuals over a broad age range. SUMMARY 4D flow MRI is a useful tool for the noninvasive, volumetric and quantitative hemodynamic assessment of neurovascular disease without the need for gadolinium contrast agents. Further improvements are warranted to overcome technical limitations before broader clinical implementation. Current developments, such as advanced acceleration techniques (parallel imaging and compressed sensing) for faster data acquisition, dual or multiple velocity encoding strategies for more accurate arterial and venous flow quantification, ultrahigh-field strengths to achieve higher spatial resolution and streamlined postprocessing workflow for more efficient and standardized flow analysis, are promising advancements in 4D flow MRI.
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Affiliation(s)
- Susanne Schnell
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Can Wu
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Sameer A. Ansari
- Dept. of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Dept. of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Ha H, Kim GB, Kweon J, Lee SJ, Kim YH, Lee DH, Yang DH, Kim N. Hemodynamic Measurement Using Four-Dimensional Phase-Contrast MRI: Quantification of Hemodynamic Parameters and Clinical Applications. Korean J Radiol 2016; 17:445-62. [PMID: 27390537 PMCID: PMC4936168 DOI: 10.3348/kjr.2016.17.4.445] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/22/2016] [Indexed: 11/21/2022] Open
Abstract
Recent improvements have been made to the use of time-resolved, three-dimensional phase-contrast (PC) magnetic resonance imaging (MRI), which is also named four-dimensional (4D) PC-MRI or 4D flow MRI, in the investigation of spatial and temporal variations in hemodynamic features in cardiovascular blood flow. The present article reviews the principle and analytical procedures of 4D PC-MRI. Various fluid dynamic biomarkers for possible clinical usage are also described, including wall shear stress, turbulent kinetic energy, and relative pressure. Lastly, this article provides an overview of the clinical applications of 4D PC-MRI in various cardiovascular regions.
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Affiliation(s)
- Hojin Ha
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang 37673, Korea
| | - Guk Bae Kim
- Asan Institute of Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jihoon Kweon
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Sang Joon Lee
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang 37673, Korea.; Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Namkug Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.; Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
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Turski P, Scarano A, Hartman E, Clark Z, Schubert T, Rivera L, Wu Y, Wieben O, Johnson K. Neurovascular 4DFlow MRI (Phase Contrast MRA): emerging clinical applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0019-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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49
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Yoon NK, McNally S, Taussky P, Park MS. Imaging of cerebral aneurysms: a clinical perspective. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0016-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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50
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Advanced flow MRI: emerging techniques and applications. Clin Radiol 2016; 71:779-95. [PMID: 26944696 DOI: 10.1016/j.crad.2016.01.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) techniques provide non-invasive and non-ionising methods for the highly accurate anatomical depiction of the heart and vessels throughout the cardiac cycle. In addition, the intrinsic sensitivity of MRI to motion offers the unique ability to acquire spatially registered blood flow simultaneously with the morphological data, within a single measurement. In clinical routine, flow MRI is typically accomplished using methods that resolve two spatial dimensions in individual planes and encode the time-resolved velocity in one principal direction, typically oriented perpendicular to the two-dimensional (2D) section. This review describes recently developed advanced MRI flow techniques, which allow for more comprehensive evaluation of blood flow characteristics, such as real-time flow imaging, 2D multiple-venc phase contrast MRI, four-dimensional (4D) flow MRI, quantification of complex haemodynamic properties, and highly accelerated flow imaging. Emerging techniques and novel applications are explored. In addition, applications of these new techniques for the improved evaluation of cardiovascular (aorta, pulmonary arteries, congenital heart disease, atrial fibrillation, coronary arteries) as well as cerebrovascular disease (intra-cranial arteries and veins) are presented.
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