E. Marielle H. Bosboom
Maastricht University
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Featured researches published by E. Marielle H. Bosboom.
Journal of Biomechanical Engineering-transactions of The Asme | 2007
L Lambert Speelman; Ajay Bohra; E. Marielle H. Bosboom; Geert Willem H. Schurink; Fn Frans van de Vosse; Michel S. Makaroun; David A. Vorp
It is generally acknowledged that rupture of an abdominal aortic aneurysm (AAA) occurs when the stress acting on the wall over the cardiac cycle exceeds the strength of the wall. Peak wall stress computations appear to give a more accurate rupture risk assessment than AAA diameter, which is currently used for a diagnosis. Despite the numerous studies utilizing patient-specific wall stress modeling of AAAs, none investigated the effect of wall calcifications on wall stress. The objective of this study was to evaluate the influence of calcifications on patient-specific finite element stress computations. In addition, we assessed whether the effect of calcifications could be predicted directly from the CT-scans by relating the effect to the amount of calcification present in the AAA wall. For 6 AAAs, the location and extent of calcification was identified from CT-scans. A finite element model was created for each AAA and the areas of calcification were defined node-wise in the mesh of the model. Comparisons are made between maximum principal stress distributions, computed without calcifications and with calcifications with varying material properties. Peak stresses are determined from the stress results and related to a calcification index (CI), a quantification of the amount of calcification in the AAA wall. At calcification sites, local stresses increased, leading to a peak stress increase of 22% in the most severe case. Our results displayed a weak correlation between the CI and the increase in peak stress. Additionally, the results showed a marked influence of the calcification elastic modulus on computed stresses. Inclusion of calcifications in finite element analysis of AAAs resulted in a marked alteration of the stress distributions and should therefore be included in rupture risk assessment. The results also suggest that the location and shape of the calcified regions--not only the relative amount--are considerations that influence the effect on AAA wall stress. The dependency of the effect of the wall stress on the calcification elastic modulus points out the importance of determination of the material properties of calcified AAA wall.
Journal of Vascular Surgery | 2010
L Lambert Speelman; Geert Willem H. Schurink; E. Marielle H. Bosboom; Jaap Buth; Marcel Breeuwer; Fn Frans van de Vosse; Michael Jacobs
OBJECTIVES In the decision for surgical repair of abdominal aortic aneurysms (AAAs), the maximum diameter is the main factor. Several studies have concluded that the diameter may not be reliable as rupture risk criterion for the individual patient and wall stress was found to have a higher sensitivity and specificity. The AAA wall stress may also be an influential factor in growth of the AAA. This study investigates the effect of intraluminal thrombus on the wall stress and growth rate of aneurysms, using both idealized and patient-specific AAA models in wall stress computations. METHODS Idealized AAA models were created for wall stress analysis. Thrombus was modeled as an incompressible linear elastic material and was fixed to the wall. The reduction in wall stress for a range of thrombus volumes and shear moduli was computed. For 30 patient-specific AAA models with varying thrombus volumes, the wall stress was computed with and without thrombus. The diameter growth rate was compared for AAAs with a small and large thrombus volume. The results were compared between the idealized and patient-specific models. RESULTS The thrombus caused a reduction in wall stress, which was stronger for larger thrombi and higher elastic moduli. Any AAAs with a large thrombus were found to have significant stronger growth in diameter than aneurysms with a small thrombus (P < .01). The stress reduction due to the thrombus showed the same trend for the idealized and patient-specific models, although the effect was overestimated by the idealized models and a considerable variation between patients was observed. CONCLUSION A larger thrombus in AAA was associated with a higher AAA growth rate, but also with a lower wall stress. Therefore, weakening of the AAA wall, under the influence of thrombus, may play a more imminent role in the process of AAA growth than the stress acting on the wall.
Journal of Biomechanics | 2010
Harald C. Groen; Lenette Simons; Quirijn J.A. van den Bouwhuijsen; E. Marielle H. Bosboom; Frank J. H. Gijsen; Alina G. van der Giessen; Frans N. van de Vosse; Albert Hofman; Antonius F.W. van der Steen; Jacqueline C. M. Witteman; Aad van der Lugt; Jolanda J. Wentzel
Accurate assessment of wall shear stress (WSS) is vital for studies on the pathogenesis of atherosclerosis. WSS distributions can be obtained by computational fluid dynamics (CFD) using patient-specific geometries and flow measurements. If patient-specific flow measurements are unavailable, in- and outflow have to be estimated, for instance by using Murrays Law. It is currently unknown to what extent this law holds for carotid bifurcations, especially in cases where stenoses are involved. We performed flow measurements in the carotid bifurcation using phase-contrast MRI in patients with varying degrees of stenosis. An empirical relation between outflow and degree of area stenosis was determined and the outflow measurements were compared to estimations based on Murrays Law. Furthermore, the influence of outflow conditions on the WSS distribution was studied. For bifurcations with an area stenosis smaller than 65%, the outflow ratio of the internal carotid artery (ICA) to the common carotid artery (CCA) was 0.62+/-0.12 while the outflow ratio of the external carotid artery (ECA) was 0.35+/-0.13. If the area stenosis was larger than 65%, the flow to the ICA decreased linearly to zero at 100% area stenosis. The empirical relation fitted the flow data well (R(2)=0.69), whereas Murrays Law overestimated the flow to the ICA substantially for larger stenosis, resulting in an overestimation of the WSS. If patient-specific flow measurements of the carotid bifurcation are unavailable, estimation of the outflow ratio by the presented empirical relation will result in a good approximation of calculated WSS using CFD.
PLOS ONE | 2012
Aron S. Bode; Wouter Huberts; E. Marielle H. Bosboom; Wilco Kroon; Wim van der Linden; R. Nils Planken; Frans N. van de Vosse; Jan H. M. Tordoir
Introduction Inadequate flow enhancement on the one hand, and excessive flow enhancement on the other hand, remain frequent complications of arteriovenous fistula (AVF) creation, and hamper hemodialysis therapy in patients with end-stage renal disease. In an effort to reduce these, a patient-specific computational model, capable of predicting postoperative flow, has been developed. The purpose of this study was to determine the accuracy of the patient-specific model and to investigate its feasibility to support decision-making in AVF surgery. Methods Patient-specific pulse wave propagation models were created for 25 patients awaiting AVF creation. Model input parameters were obtained from clinical measurements and literature. For every patient, a radiocephalic AVF, a brachiocephalic AVF, and a brachiobasilic AVF configuration were simulated and analyzed for their postoperative flow. The most distal configuration with a predicted flow between 400 and 1500 ml/min was considered the preferred location for AVF surgery. The suggestion of the model was compared to the choice of an experienced vascular surgeon. Furthermore, predicted flows were compared to measured postoperative flows. Results Taken into account the confidence interval (25th and 75th percentile interval), overlap between predicted and measured postoperative flows was observed in 70% of the patients. Differentiation between upper and lower arm configuration was similar in 76% of the patients, whereas discrimination between two upper arm AVF configurations was more difficult. In 3 patients the surgeon created an upper arm AVF, while model based predictions allowed for lower arm AVF creation, thereby preserving proximal vessels. In one patient early thrombosis in a radiocephalic AVF was observed which might have been indicated by the low predicted postoperative flow. Conclusions Postoperative flow can be predicted relatively accurately for multiple AVF configurations by using computational modeling. This model may therefore be considered a valuable additional tool in the preoperative work-up of patients awaiting AVF creation.
Journal of Magnetic Resonance Imaging | 2012
Maarten A.G. Merkx; Javier Oliván Bescós; Liesbeth Geerts; E. Marielle H. Bosboom; Fn Frans van de Vosse; Marcel Breeuwer
To evaluate the accuracy and precision of manual and automatic blood vessel diameter measurements, a quantitative comparison was conducted, using both phantom and clinical 3D magnetic resonance angiography (MRA) data. Since diameters are often manually measured, which likely is influenced by operator dependency, automatic lumen delineation, based on the full‐width at half‐maximum (FWHM), could improve these measurements.
Journal of Magnetic Resonance Imaging | 2014
V. Lai Nguyen; Walter H. Backes; M. Eline Kooi; Mirthe C.J. Wishaupt; Femke A. M. V. I. Hellenthal; E. Marielle H. Bosboom; Rob J. van der Geest; Geert Willem H. Schurink; Tim Leiner
To investigate the feasibility and reproducibility of dynamic contrast‐enhanced MRI (DCE‐MRI) to quantify abdominal aortic aneurysm (AAA) vessel wall enhancement dynamics which may reflect the amount of wall microvasculature. AAA vessel wall microvasculature has been linked with aneurysm progression and rupture.
Journal of Vascular Access | 2013
Maarten A.G. Merkx; E. Marielle H. Bosboom; Aron S. Bode; Javier Oliván Bescós; Marcel Breeuwer; Jan H. M. Tordoir; Fn Frans van de Vosse
Purpose The aim of this work was to establish the relationship between traditional blood vessel mapping for vascular access (VA) creation by B-mode ultrasound (US) and novel non contrast-enhanced magnetic resonance angiography (NCE-MRA), and to study the potential influence of the diameter assessment technique on the choice of hemodialysis vascular access. Methods A total of 27 end-stage renal-disease patients were included. They received routine US and a NCE-MRA examination of the upper extremity. Diameters were measured manually on US and semi-automatically on NCE-MRA. These measurements were statistically compared for the arteries and veins and for each measurement location. Furthermore, sensitivity and specificity of both modalities to predict VA location was investigated by comparison with an experienced surgeon. This analysis gave insight into the potential influence of vessel mapping modality on decision-making. Results Comparison of NCE-MRA with US for the arteries and veins, demonstrated a bias of 9% (limits −33%-78%) and 38% (limits −36%-198%), respectively. Statistically significant differences between the modalities on the individual locations were mainly found for the venous locations. The sensitivity and specificity for US to predict VA location was 1.0 and 0.74, respectively, while for NCE-MRA this was 0.88 and 0.39, respectively. Conclusions The results obtained indicate that extreme caution should be exercised when replacing one diameter measurement modality with the other. A further need exists to improve both vessel mapping protocols to obtain a geometric description of the upper extremity vasculature regardless of acquisition modality.
PLOS ONE | 2013
Maarten A.G. Merkx; Wouter Huberts; E. Marielle H. Bosboom; Aron S. Bode; Javier Oliván Bescós; Jan H. M. Tordoir; Marcel Breeuwer; Fn Frans van de Vosse
Introduction Vascular access (VA) surgery, a prerequisite for hemodialysis treatment of end-stage renal-disease (ESRD) patients, is hampered by complication rates, which are frequently related to flow enhancement. To assist in VA surgery planning, a patient-specific computer model for postoperative flow enhancement was developed. The purpose of this study is to assess the benefit of non contrast-enhanced magnetic resonance angiography (NCE-MRA) data as patient-specific geometrical input for the model-based prediction of surgery outcome. Methods 25 ESRD patients were included in this study. All patients received a NCE-MRA examination of the upper extremity blood vessels in addition to routine ultrasound (US). Local arterial radii were assessed from NCE-MRA and converted to model input using a linear fit per artery. Venous radii were determined with US. The effect of radius measurement uncertainty on model predictions was accounted for by performing Monte-Carlo simulations. The resulting flow prediction interval of the computer model was compared with the postoperative flow obtained from US. Patients with no overlap between model-based prediction and postoperative measurement were further analyzed to determine whether an increase in geometrical detail improved computer model prediction. Results Overlap between postoperative flows and model-based predictions was obtained for 71% of patients. Detailed inspection of non-overlapping cases revealed that the geometrical details that could be assessed from NCE-MRA explained most of the differences, and moreover, upon addition of these details in the computer model the flow predictions improved. Conclusions The results demonstrate clearly that NCE-MRA does provide valuable geometrical information for VA surgery planning. Therefore, it is recommended to use this modality, at least for patients at risk for local or global narrowing of the blood vessels as well as for patients for whom an US-based model prediction would not overlap with surgical choice, as the geometrical details are crucial for obtaining accurate flow predictions.
ASME 2010 Summer Bioengineering Conference, Parts A and B | 2010
Harald C. Groen; Lenette Simons; E. Marielle H. Bosboom; Fn Frans van de Vosse; Anton F. W. van der Steen; Aad van der Lugt; Frank J. H. Gijsen; J.J. Wentzel
Many studies have been performed to investigate the contribution of wall shear stress (WSS) to pathophysiological processes related to atherosclerosis (Groen, et al., 2007; Kaazempur-Mofrad, et al., 2004; Ku, et al., 1985). To investigate these relationships in stenosed human carotid arteries, accurate assessment of WSS is required. WSS can be calculated in vivo by coupling medical imaging and computational fluid dynamics (CFD). However, often patient specific in- and outflow information is unavailable. Therefore flow through the common (CCA), internal (ICA) and external (ECA) carotid artery needs to be estimated. Murray’s law (Murray, 1926) is often used for that purpose, but it is unclear whether this law holds for stenosed arteries. The goal of this study was to determine outflow boundary conditions for WSS calculations in stenosed carotid bifurcations. Therefore we first quantified the flow (Q) in carotid arteries with different degrees of area stenosis using phase-contrast MRI and determined an empirical relation between outflow-ratios and degree of area stenosis. Secondly we compared the estimated flow ratio based on Murray’s law to the ones measured by MRI. Finally we analyzed the influence of the outflow conditions on the calculated WSS using CFD.Copyright
ASME 2010 Summer Bioengineering Conference, Parts A and B | 2010
Lambert Speelman; Femke A. M. V. I. Hellenthal; E. Marielle H. Bosboom; Jaap Buth; Marcel Breeuwer; Michael J. Jacobs; Fn Frans van de Vosse; Geert Willem H. Schurink
In the decision for surgical repair of abdominal aortic aneurysms (AAAs), the risk of rupture is weighed carefully against the risk of the surgical procedure. The risk of rupture is estimated based on the maximum diameter and the growth rate of the AAA. Previous studies indicate that AAA growth rate increases with the diameter of the AAA [1, 2]. However, this growth rate is not the same for each AAA, as some AAA’s remain stable over a long period of time, while others show a fast growth or grow discontinuously.Copyright