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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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Futami K, Misaki K, Uno T, Nambu I, Tsutsui T, Kamide T, Nakada M. Minimum wall shear stress points and their underlying intra-aneurysmal flow structures of unruptured cerebral aneurysms on 4D flow MRI. J Neuroradiol 2022; 50:302-308. [PMID: 36084742 DOI: 10.1016/j.neurad.2022.09.001] [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: 07/18/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Minimum wall shear stress (Min-WSS) points may be associated with wall instability of unruptured cerebral aneurysms. We aimed to investigate the relationship between the locations of Min-WSS points and their underlying intra-aneurysmal flow structure patterns in unruptured cerebral aneurysms using four-dimensional (4D) flow magnetic resonance imaging (MRI). MATERIALS AND METHODS Min-WSS points and the intra-aneurysmal flow structure patterns were identified in 50 unruptured aneurysms by 4D flow MRI. RESULTS The Min-WSS points were located around a vortex core tip in 31 (62.0%) aneurysms and on an intra-bleb vortex center in 7 (14.0%). Sixteen (32.0%) aneurysms had the Min-WSS points on the aneurysmal apex, and in 24 (48.0%) were on the neck. The Min-WSS values of aneurysms with the Min-WSS points on an intra-bleb flow were significantly lower than those of the other groups (P = 0.030). Aneurysms with the Min-WSS points on the neck had significantly higher Min-WSS values than the other aneurysms (P = 0.008). CONCLUSIONS The location of the Min-WSS point was corresponding to the vortex core or center in 76% of all aneurysms. The underlying intra-aneurysmal flow structure and location of the Min-WSS point affect the Min-WSS value. Further studies are needed to characterize Min-WSS points to identify aneurysms with a higher risk of wall instability.
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Affiliation(s)
- Kazuya Futami
- Department of Neurosurgery, Hokuriku Central Hospital, 123 Nodera, Oyabe, 932-8503 Toyama, Japan.
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan.
| | - Takehiro Uno
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan.
| | - Iku Nambu
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan.
| | - Taishi Tsutsui
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan.
| | - Tomoya Kamide
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan.
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan.
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Fu M, Peng F, Zhang M, Chen S, Niu H, He X, Xu B, Liu A, Li R. Aneurysmal wall enhancement and hemodynamics: pixel-level correlation between spatial distribution. Quant Imaging Med Surg 2022; 12:3692-3704. [PMID: 35782262 PMCID: PMC9246729 DOI: 10.21037/qims-21-1203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/29/2022] [Indexed: 03/22/2024]
Abstract
BACKGROUND Inflammation and hemodynamics are interrelated risk factors for intracranial aneurysm rupture. This study aimed to identify the relationship between these risk factors from an individual-patient perspective using biomarkers of aneurysm wall enhancement (AWE) derived from high-resolution magnetic resonance imaging (HR-MRI) and hemodynamic parameters by four-dimensional flow MRI (4D-flow MRI). METHODS A total of 29 patients with 29 unruptured intracranial aneurysms larger than 4 mm were included in this prospective cross-sectional study. A total of 24 aneurysms had AWE and 5 did not have AWE. A three-dimensional (3D) vessel model of each individual aneurysm was generated with 3D time-of-flight magnetic resonance angiography (3D TOF-MRA). Quantification of AWE was sampled with HR-MRI. Time-averaged wall shear stress (WSS) and oscillatory shear index (OSI) were calculated from the 4D-flow MRI. The correlation between spatial distribution of AWE and hemodynamic parameters measured at pixel-level was evaluated for each aneurysm. RESULTS In aneurysms with AWE, the spatial distribution of WSS was negatively correlated with AWE in 100% (24/24) of aneurysms, though 2 had an absolute value of the correlation coefficient <0.1. The OSI was positively correlated with AWE in 91.7% (22/24) of aneurysms; the other 2 aneurysms showed a negative correlation with AWE. In aneurysms with no AWE, there was no correlation between WSS (100%, 5/5), OSI (80%, 4/5), and wall inflammation. CONCLUSIONS The spatial distribution of WSS was negatively correlated with AWE in aneurysms with AWE, and OSI was positively correlated with AWE in most aneurysms with AWE. While aneurysms that did not contain AWE showed no correlation between hemodynamics and wall inflammation.
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Affiliation(s)
- Mingzhu Fu
- 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Miaoqi Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Shuo 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, 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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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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Inflow Hemodynamics of Intracranial Aneurysms: A Comparison of Computational Fluid Dynamics and 4D Flow Magnetic Resonance Imaging. J Stroke Cerebrovasc Dis 2021; 30:105685. [PMID: 33662703 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105685] [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: 01/03/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Although the inflow hemodynamics of cerebral aneurysms are key factors in their rupture and recurrence after endovascular treatments, the most available method for inflow hemodynamics evaluation remains unestablished. We compared the efficacy of inflow hemodynamics evaluation using computational fluid dynamics (CFD) analysis and that using four-dimensional (4D) flow magnetic resonance imaging (MRI). METHODS In 23 unruptured cerebral aneurysms, the inflow hemodynamics was evaluated using both CFD and 4D flow MRI. The evaluated parameters included visually classified inflow jet patterns, the inflow rate ratio (the ratio of the inflow rate at the aneurysmal orifice to the flow rate in the proximal parent artery), and the velocity ratio (the ratio of the inflow velocity to the velocity in the proximal parent artery). The Shapiro-Wilk test was used to assess the normality of variable data, and logarithmic transformation was performed for variables with non-normal distributions. Data analysis was performed using Pearson correlation analyses and the chi-square test. RESULTS There was a significant correlation between inflow jet patterns evaluated by CFD and 4D flow MRI (p = 0.008). Moreover, there was a strong correlation between the inflow rate ratios evaluated by CFD and 4D flow MRI (r = 0.801; p <0.001). Furthermore, there was a moderate correlation between the velocity ratios measured by CFD and 4D flow MRI (r = 0.559; p = 0.008). CONCLUSION Inflow hemodynamics evaluated by CFD analysis and 4D flow MRI showed good correlations in inflow jet pattern, inflow rate ratio, and velocity ratio.
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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: 12] [Impact Index Per Article: 4.0] [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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7
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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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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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Futami K, Misaki K, Uno T, Kamide T, Nakada M. Effect of Neck Size on the Inflow Magnitude Evaluated on 4D Flow MRI in Unruptured Internal Carotid Artery Aneurysms. J Stroke Cerebrovasc Dis 2020; 29:105116. [PMID: 32912568 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND A neck size >4.0 mm is a risk factor for recanalization after coil embolization. The high inflow magnitude of pretreatment wide-neck aneurysms may be correlated to recanalization. We aimed to elucidate the effect of the neck size on the inflow magnitude evaluated on four-dimensional (4D) flow magnetic resonance imaging (MRI) in pretreatment unruptured internal carotid artery (ICA) aneurysms. METHODS Thirty-three untreated ICA aneurysms were subjected to 4D flow MRI to evaluate the inflow magnitude parameters including the maximum spatially-averaged inflow velocity (MSAIV), maximum inflow velocity, maximum inflow rate (MIR), and their ratios to each corresponding flow parameter in the parent artery. RESULTS The neck size was linearly correlated to all inflow parameters investigated in this study. A strong correlation was observed between the neck size and the following: MSAIV (r = .755, p < .0001), MIR (r = .715, p < .0001), MSAIV ratio (r = .724, p < .0001), and MIR ratio (r = .741, p < .0001). The predicted value of MIR ratio of an aneurysm with the neck size of 4.0 mm was 23.0% and 20.6%, based on the linear regression equation of all aneurysms and on that of aneurysms with the neck size >4.0 mm, respectively. CONCLUSIONS The neck size was linearly correlated with the inflow magnitude of unruptured ICA aneurysms. Inflow magnitude evaluation using 4D flow MRI may help to hemodynamically identify aneurysms with a high risk of recanalization after endovascular coil embolization.
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Affiliation(s)
- Kazuya Futami
- Department of Neurosurgery, Hokuriku Central Hospital, 123 Nodera, Oyabe, 932-8503 Toyama, Japan.
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Takehiro Uno
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
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10
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Su T, Reymond P, Brina O, Bouillot P, Machi P, Delattre BMA, Jin L, Lövblad KO, Vargas MI. Large Neck and Strong Ostium Inflow as the Potential Causes for Delayed Occlusion of Unruptured Sidewall Intracranial Aneurysms Treated by Flow Diverter. AJNR Am J Neuroradiol 2020; 41:488-494. [PMID: 32054620 DOI: 10.3174/ajnr.a6413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diverter-induced hemodynamic change plays an important role in the mechanism of intracranial aneurysm occlusion. Our aim was to explore the relationship between aneurysm features and flow-diverter treatment of unruptured sidewall intracranial aneurysms. MATERIALS AND METHODS MR imaging, 4D phase-contrast, was prospectively performed before flow diverter implantation in each patient with unruptured intracranial aneurysm. Two postprocedure follow-ups were scheduled at 6 and 12 months. Responses were grouped according to whether the aneurysms were occluded or remnant. Preprocedural aneurysm geometries and ostium hemodynamics in 38 patients were compared between the 2 groups at 6 and 12 months. Receiver operating characteristic curve analyses were performed for significant geometric and hemodynamic continuous parameters. RESULTS After the 6-month assessment, 21 of 41 intracranial aneurysms were occluded, and 9 additional aneurysms were occluded at 12 months. Geometrically, the ostium maximum diameter was significantly larger in the remnant group at 6 and 12 months (both P < .001). Hemodynamically, the proximal inflow zone was more frequently observed in the remnant group at 6 months. Several preprocedural ostium hemodynamic parameters were significantly higher in the remnant group. As a prediction for occlusion, the areas under the curve of the ostium maximum diameter (for 6 and 12 months), systolic inflow rate ratio (for 6 months), and systolic inflow area (for 12 months) reached 0.843, 0.883, 0.855, and 0.860, respectively. CONCLUSIONS Intracranial aneurysms with a large ostium and strong ostium inflow may need a longer time for occlusion. Preprocedural 4D flow MR imaging can well illustrate ostium hemodynamics and characterize aneurysm treatment responses.
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Affiliation(s)
- T Su
- From the Department of Interventional Radiology (T.S., L.J.), Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - P Reymond
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - O Brina
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - P Bouillot
- and Division of Radiology (B.M.A.D.), University Hospitals of Geneva, Geneva, Switzerland
| | - P Machi
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - B M A Delattre
- Department of Quantum Matter Physics (P.B.), University of Geneva, Geneva, Switzerland
| | - L Jin
- From the Department of Interventional Radiology (T.S., L.J.), Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - K O Lövblad
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
| | - M I Vargas
- Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.)
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Futami K, Uno T, Misaki K, Tamai S, Nambu I, Uchiyama N, Nakada M. Identification of Vortex Cores in Cerebral Aneurysms on 4D Flow MRI. AJNR Am J Neuroradiol 2019; 40:2111-2116. [PMID: 31753836 DOI: 10.3174/ajnr.a6322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The complexity and instability of the vortex flow in aneurysms are factors related to the rupture risk of unruptured cerebral aneurysms. We identified aneurysm vortex cores on 4D flow MR imaging and examined the relationship of these factors with the characteristics of cerebral aneurysms. MATERIALS AND METHODS We subjected 40 aneurysms (37 unruptured, 3 ruptured) to 4D flow MR imaging. We visualized streamlines with velocities below the threshold-that is, a percentage value of the aneurysm maximum inflow velocity-and progressively decreased the threshold to identify vortex cores as thin, streamline bundles with minimum velocities. Complexity and stability were compared in aneurysms with a smooth surface and those with blebs or daughter sacs. RESULTS The threshold for visualizing vortex cores ranged from 3% to 13% of the maximum inflow velocity. Vortex cores could be visualized in 38 aneurysms; in 2, they were not visualized through the cardiac cycle. A simple flow pattern (single vortex core) was identified in 27 aneurysms; the other 13 exhibited a complex flow pattern. The cores were stable in 32 and unstable in 8 aneurysms. Significantly more aneurysms with-than-without blebs or daughter sacs had a complex flow pattern (P = .006). Of the 3 ruptured aneurysms, 1 aneurysm had an unstable vortex core; in the other 2, the vortex core was not visualized. CONCLUSIONS The identification of vortex cores on 4D flow MR imaging may help to stratify the rupture risk of unruptured cerebral aneurysms.
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Affiliation(s)
- K Futami
- From the Department of Neurosurgery (K.F.), Hokuriku Central Hospital, Toyama, Japan
| | - T Uno
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - K Misaki
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - S Tamai
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - I Nambu
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - N Uchiyama
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - M Nakada
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
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Inflow hemodynamics evaluated by using four-dimensional flow magnetic resonance imaging and the size ratio of unruptured cerebral aneurysms. Neuroradiology 2017; 59:411-418. [DOI: 10.1007/s00234-017-1801-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/02/2017] [Indexed: 11/27/2022]
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