Influence of head position on carotid hemodynamics in young adults.

Studies in adults have shown marked changes in geometry and relative positions of the carotid arteries when rotating the head. The aim of this study was to quantify the change in geometry and analyze its effect on carotid hemodynamics as a result of head rotation. The right carotid arteries of nine young adult subjects were investigated in supine position with straight and left turned head positions, respectively. The three-dimensional (3D) carotid geometry was reconstructed by using 3D ultrasound (3D US), and the carotid hemodynamics were calculated by combining 3D US with computational fluid dynamics. It was observed that cross-sectional areas and shapes did not change markedly with head rotation, but carotid vessel center lines altered with planarification of the common carotid artery as a main feature (P < 0.05). Measured common carotid flow rates changed significantly at the individual level when the head was turned, but on the average, the change in mean common carotid flow rate was relatively small (0.37 +/- 1.11 ml/s). The effect of the altered center lines and flow rates on the atherogenic nature of the carotid bifurcation was evaluated by using calculated hemodynamic wall parameters, such as wall shear stress (WSS) and oscillatory shear index (OSI). It was found that WSS and OSI patterns changed significantly with head rotation, but the variations were very subject dependent and could not have been predicted without assessing the altered geometry and flow of the carotid bifurcation for individual cases. This study suggests that there is a need for standardization of the choice of head position in the 3D US scan protocol, and that carotid stents and emboli diverters should be studied in different head positions.

The integration of medical imaging and computational fluid dynamics for measuring wall shear stress in carotid arteries.

The link between atherosclerosis and wall shear stress (WSS) has lead to considerable interest in the in vivo estimation of WSS. Both magnetic resonance imaging (MRI) and three-dimensional ultrasound (3DUS) are capable of providing the anatomical and flow data required for subject-specific computational fluid dynamics (CFD) simulations. This study compares, for the first time, predicted 3D flow patterns based on black blood MRI and 3DUS. Velocity fields in the carotid arteries of nine subjects have been reconstructed, and the haemodynamic wall parameters WSS, oscillatory shear index (OSI), WSS gradients (WSSG) and angle gradients (WSSAG) were computed and compared. There was a good qualitative agreement between results derived from MRI and 3DUS, embodied by a strong linear correlation between the patched representations of the haemodynamic wall parameters. The root-mean-square error between haemodynamic wall parameters was comparable to the range of the expected variability of each imaging technique (WSS: 0.411 N/m; OSI: 0.048; temporal WSSG: 2.29 N/(s.m/sup 2/); spatial WSSG: 150 N/m/sup 3/; WSSAG: 87.6 rad/m). In conclusion, MRI and 3DUS are comparable techniques for combining with CFD in the carotid artery. The relatively high cost of MRI favour 3DUS to MRI for future haemodynamic studies of superficial arteries.

Image-based carotid flow reconstruction: a comparison between MRI and ultrasound.

Atherosclerosis is a major cause of morbidity and mortality. Its apparent link with wall shear stress (WSS) has led to considerable interest in the in vivo estimation of WSS. Determining WSS by combining medical images with computational fluid dynamics (CFD) simulations can be performed both with magnetic resonance imaging (MRI) and three-dimensional ultrasound (3DUS). This study compares predicted 3D flow patterns based on black blood MRI and 3DUS. Velocity fields in the carotid arteries of nine subjects have been reconstructed, and the haemodynamic wall parameters WSS, oscillatory shear index (OSI), WSS gradients (WSSG) and angle gradients (WSSAG) were compared between the two imaging techniques. There was a good qualitative agreement between results derived from MRI and 3DUS (average correlation strength above 0.60). The root mean square error between haemodynamic wall parameters was comparable to the range of the expected variability of each imaging technique (WSS: 0.411 N m(-2); OSI: 0.048; temporal WSSG: 150 N s(-1) m(-2); spatial WSSG: 2.29 N m(-3); WSSAG: 87.6 rad m(-1)). In conclusion, MRI and 3DUS are capable of providing haemodynamic parameters when combined with CFD, and the predictions are in most cases qualitatively and quantitatively similar. The relatively high cost of MRI and continuing improvement in ultrasound favour US to MRI for future haemodynamic studies of superficial arteries.

Accuracy and reproducibility of CFD predicted wall shear stress using 3D ultrasound images.

Computational fluid dynamics (CFD) flow simulation techniques have the potential to enhance our understanding of how haemodynamic factors are involved in atherosclerosis. Recently, 3D ultrasound has emerged as an alternative to other 3D imaging techniques, such as magnetic resonance angiography (MRA). The method can be used to generate realistic vascular geometry suitable for CFD simulations. In order to assess accuracy and reproducibility of the procedure from image acquisition to reconstruction to CFD simulation, a human carotid artery bifurcation phantom was scanned three times using 3D ultrasound. The geometry was reconstructed and flow simulations were carried out on the three sets as well as on a model generated using computer aided design (CAD) from the geometric information given by the manufacturer. It was found that the three reconstructed sets showed good reproducibility as well as satisfactory quantitative agreement with the CAD model. Analyzing two selected locations probably representing the 'worst cases,' accuracy comparing ultrasound and CAD reconstructed models was estimated to be between 7.2% and 7.7% of the maximum instantaneous WSS and reproducibility comparing the three scans to be between 8.2% and 10.7% of their average maximum.

Reproducibility study of magnetic resonance image-based computational fluid dynamics prediction of carotid bifurcation flow.

The importance of shear stress in the initiation and progression of atherosclerosis has been recognized for some time. A novel way to quantify wall shear stress under physiologically realistic conditions is to combine magnetic resonance imaging (MRI) and computational fluid dynamics. The present study aims to investigate the reproducibility of the simulated flow by using this combined approach. The right carotid bifurcations of eight healthy subjects were scanned twice with MRI within a few weeks. Three-dimensional geometries of the vessels were reconstructed for each scan and each subject. Pulsatile flows through these models were calculated to assess errors associated with the predicted flow parameters. This was done by comparing various wall shear stress indices, including the time-averaged wall shear stress (WSS), oscillating shear index (OSI), WSS Gradients (WSSG) and WSS Angle Deviation (WSSAD). Qualitatively, all the wall shear parameters proved to be highly reproducible. Quantitatively, the reproducibility was over 90% for OSI and WSSAD, but less impressive (60%) for other parameters. Our results indicated that WSS and WSSG values were extremely sensitive to subtle variations in local geometry and mesh design, particularly in regions around the bifurcation apex where WSS values were high and least reproducible.

Carotid geometry reconstruction: a comparison between MRI and ultrasound.

Image-based Computational Fluid Dynamics (CFD) has become a popular tool for the prediction of in vivo flow profiles and hemodynamic wall parameters. Currently, Magnetic Resonance Imaging (MRI) is most widely used for in vivo geometry acquisition. For superficial arteries such as the carotids and the femoral artery, three-dimensional (3-D) extravascular ultrasound (3-DUS) could be a cost-effective alternative to MRI. In this study, nine healthy subjects were scanned both with MRI and 3-DUS. The reconstructed carotid artery geometries for each subject were compared by evaluating cross-sectional areas, centerlines, and carotid nonplanarity. Lumen areas agreed very well between the two different acquisition techniques, whereas centerlines and nonplanarity parameters showed measurable disagreement, possibly due to the different neck and head positions adopted for 3-DUS versus MRI. With the current level of agreement achieved, 3-DUS has the potential to become an inexpensive and fast alternative to MRI for image-based CFD modeling of superficial arteries.

Validation of the coupling of magnetic resonance imaging velocity measurements with computational fluid dynamics in a U bend.

Magnetic resonance imaging (MRI) can be used in vivo in combination with computational fluid dynamics (CFD) to derive velocity profiles in space and time and accordingly, pressure drop and wall shear stress distribution in natural or artificial vessel segments. These hemodynamic data are difficult or impossible to acquire directly in vivo. Therefore, research has been performed combining MRI and CFD for flow simulations in flow phantoms, such as bends or anastomoses, and even in human vessels such as the aorta, the carotid, and the abdominal bifurcation. There is, however, no unanimity concerning the use of MRI velocity measurements as input for the inflow boundary condition of a CFD simulation. In this study, different input possibilities for the inflow boundary conditions are compared. MRI measurements of steady and pulsatile flow were performed on a U bend phantom, representing the aorta geometry. PAMFLOW (ESI Software, Krimpen aan den Ussel, The Netherlands), an industrial CFD software package, was used to solve the Navier-Stokes equations for incompressible flow. Three main parameters were found to influence the choice of an inflow boundary condition type. First, the flow rate through a vessel should be exact, since it proves to be a determining factor for the accuracy of the velocity profile. The other decisive parameters are the physiology of the flow profile and the required computer processing unit time. Our comparative study indicates that the best way to handle an inflow boundary condition is to use the velocities measured by MRI at the inflow plane as being fixed velocities. However, before using these MRI velocity data, they first should be corrected for the partial volume effect by filtering and second scaled in order to obtain the correct flow rate. This implies that a reliable flow rate measurement absolutely is needed for CFD calculations based on MRI velocity measurements.