Oliver Beuing

The FLOWLENS: A Focus-and-Context Visualization Approach for Exploration of Blood Flow in Cerebral Aneurysms

Blood flow and derived data are essential to investigate the initiation and progression of cerebral aneurysms as well as their risk of rupture. An effective visual exploration of several hemodynamic attributes like the wall shear stress (WSS) and the inflow jet is necessary to understand the hemodynamics. Moreover, the correlation between focus-and-context attributes is of particular interest. An expressive visualization of these attributes and anatomic information requires appropriate visualization techniques to minimize visual clutter and occlusions. We present the FLOWLENS as a focus-and-context approach that addresses these requirements. We group relevant hemodynamic attributes to pairs of focus-and-context attributes and assign them to different anatomic scopes. For each scope, we propose several FLOWLENS visualization templates to provide a flexible visual filtering of the involved hemodynamic pairs. A template consists of the visualization of the focus attribute and the additional depiction of the context attribute inside the lens. Furthermore, the FLOWLENS supports local probing and the exploration of attribute changes over time. The FLOWLENS minimizes visual cluttering, occlusions, and provides a flexible exploration of a region of interest. We have applied our approach to seven representative datasets, including steady and unsteady flow data from CFD simulations and 4D PC-MRI measurements. Informal user interviews with three domain experts confirm the usefulness of our approach.

Impact of Stents and Flow Diverters on Hemodynamics in Idealized Aneurysm Models

Cerebral aneurysms constitute a major medical challenge as treatment options are limited and often associated with high risks. Statistically, up to 3% of patients with a brain aneurysm may suffer from bleeding for each year of life. Eight percent of all strokes are caused by ruptured aneurysms. In order to prevent this rupture, endovascular stenting using so called flow diverters is increasingly being regarded as an alternative to the established coil occlusion method in minimally invasive treatment. Covering the neck of an aneurysm with a flow diverter has the potential to alter the hemodynamics in such a way as to induce thrombosis within the aneurysm sac, stopping its further growth, preventing its rupture and possibly leading to complete resorption. In the present study the influence of different flow diverters is quantified considering idealized patient configurations, with a spherical sidewall aneurysm placed on either a straight or a curved parent vessel. All important hemodynamic parameters (exchange flow rate, velocity, and wall shear stress) are determined in a quantitative and accurate manner using computational fluid dynamics when varying the key geometrical properties of the aneurysm. All simulations are carried out using an incompressible, Newtonian fluid with steady conditions. As a whole, 72 different cases have been considered in this systematic study. In this manner, it becomes possible to compare the efficiency of different stents and flow diverters as a function of wire density and thickness. The results show that the intra-aneurysmal flow velocity, wall shear stress, mean velocity, and vortex topology can be considerably modified thanks to insertion of a suitable implant. Intra-aneurysmal residence time is found to increase rapidly with decreasing stent porosity. Of the three different implants considered in this study, the one with the highest wire density shows the highest increase of intra-aneurysmal residence time for both the straight and the curved parent vessels. The best hemodynamic modifications are always obtained for a small aneurysm diameter.

Cerebral Blood Flow in a Healthy Circle of Willis and Two Intracranial Aneurysms: Computational Fluid Dynamics Versus Four-Dimensional Phase-Contrast Magnetic Resonance Imaging

Computational fluid dynamics (CFD) opens up multiple opportunities to investigate the hemodynamics of the human vascular system. However, due to numerous assumptions the acceptance of CFD among physicians is still limited in practice and validation through comparison is mandatory. Time-dependent quantitative phase-contrast magnetic resonance imaging PC-MRI measurements in a healthy volunteer and two intracranial aneurysms were carried out at 3 and 7 Tesla. Based on the acquired images, three-dimensional (3D) models of the aneurysms were reconstructed and used for the numerical simulations. Flow information from the MR measurements were applied as boundary conditions. The four-dimensional (4D) velocity fields obtained by CFD and MRI were qualitatively as well as quantitatively compared including cut planes and vector analyses. For all cases a high similarity of the velocity patterns was observed. Additionally, the quantitative analysis revealed a good agreement between CFD and MRI. Deviations were caused by minor differences between the reconstructed vessel models and the actual lumen. The comparisons between diastole and systole indicate that relative differences between MRI and CFD are intensified with increasing velocity. The findings of this study lead to the conclusion that CFD and MRI agree well in predicting intracranial velocities when realistic geometries and boundary conditions are provided. Due to the considerably higher temporal and spatial resolution of CFD compared to MRI, complex flow patterns can be further investigated in order to evaluate their role with respect to aneurysm formation or rupture. Nevertheless, special care is required regarding the vessel reconstruction since the geometry has a major impact on the subsequent numerical results.

Map displays for the analysis of scalar data on cerebral aneurysm surfaces

Cerebral aneurysms result from a congenital or evolved weakness of stabilizing parts of the vessel wall and potentially lead to rupture and a life‐threatening bleeding. Current medical research concentrates on the integration of blood flow simulation results for risk assessment of cerebral aneurysms. Scalar flow characteristics close to the aneurysm surface, such as wall shear stress, form an important part of the simulation results. Aneurysms exhibit variable surface shapes with only few landmarks. Therefore, the exploration and mental correlation of different surface regions is a difficult task. In this paper, we present an approach for the intuitive and interactive overview visualization of near wall flow data that is mapped onto the surface of a 3D model of a cerebral aneurysm. We combine a multi‐perspective 2D projection map with a standard 3D visualization and present techniques to facilitate the correlation between a 3D model and a related 2D map. An informal evaluation with 4 experienced radiologists has shown that the map‐based overview actually improves the surface exploration. Furthermore, different color schemes were discussed and, as a result, an appropriate color scheme for the visual analysis of the wall shear stress is presented.

Automatic Detection and Visualization of Qualitative Hemodynamic Characteristics in Cerebral Aneurysms

Cerebral aneurysms are a pathological vessel dilatation that bear a high risk of rupture. For the understanding and evaluation of the risk of rupture, the analysis of hemodynamic information plays an important role. Besides quantitative hemodynamic information, also qualitative flow characteristics, e.g., the inflow jet and impingement zone are correlated with the risk of rupture. However, the assessment of these two characteristics is currently based on an interactive visual investigation of the flow field, obtained by computational fluid dynamics (CFD) or blood flow measurements. We present an automatic and robust detection as well as an expressive visualization of these characteristics. The detection can be used to support a comparison, e.g., of simulation results reflecting different treatment options. Our approach utilizes local streamline properties to formalize the inflow jet and impingement zone. We extract a characteristic seeding curve on the ostium, on which an inflow jet boundary contour is constructed. Based on this boundary contour we identify the impingement zone. Furthermore, we present several visualization techniques to depict both characteristics expressively. Thereby, we consider accuracy and robustness of the extracted characteristics, minimal visual clutter and occlusions. An evaluation with six domain experts confirms that our approach detects both hemodynamic characteristics reasonably.

An automatic CFD-based flow diverter optimization principle for patient-specific intracranial aneurysms

The optimal treatment of intracranial aneurysms using flow diverting devices is a fundamental issue for neuroradiologists as well as neurosurgeons. Due to highly irregular manifold aneurysm shapes and locations, the choice of the stent and the patient-specific deployment strategy can be a very difficult decision. To support the therapy planning, a new method is introduced that combines a three-dimensional CFD-based optimization with a realistic deployment of a virtual flow diverting stent for a given aneurysm. To demonstrate the feasibility of this method, it was applied to a patient-specific intracranial giant aneurysm that was successfully treated using a commercial flow diverter. Eight treatment scenarios with different local compressions were considered in a fully automated simulation loop. The impact on the corresponding blood flow behavior was evaluated qualitatively as well as quantitatively, and the optimal configuration for this specific case was identified. The virtual deployment of an uncompressed flow diverter reduced the inflow into the aneurysm by 24.4% compared to the untreated case. Depending on the positioning of the local stent compression below the ostium, blood flow reduction could vary between 27.3% and 33.4%. Therefore, a broad range of potential treatment outcomes was identified, illustrating the variability of a given flow diverter deployment in general. This method represents a proof of concept to automatically identify the optimal treatment for a patient in a virtual study under certain assumptions. Hence, it contributes to the improvement of virtual stenting for intracranial aneurysms and can support physicians during therapy planning in the future.

Recommendations for Accurate Numerical Blood Flow Simulations of Stented Intracranial Aneurysms

Abstract The number of scientific publications dealing with stented intracranial aneurysms is rapidly increasing. Powerful computational facilities are now available; an accurate computational modeling of hemodynamics in patient-specific configurations is, however, still being sought. Furthermore, there is still no general agreement on the quantities that should be computed and on the most adequate analysis for intervention support. In this article, the accurate representation of patient geometry is first discussed, involving successive improvements. Concerning the second step, the mesh required for the numerical simulation is especially challenging when deploying a stent with very fine wire structures. Third, the description of the fluid properties is a major challenge. Finally, a founded quantitative analysis of the simulation results is obviously needed to support interventional decisions. In the present work, an attempt has been made to review the most important steps for a high-quality computational fluid dynamics computation of virtually stented intracranial aneurysms. In consequence, this leads to concrete recommendations, whereby the obtained results are not discussed for their medical relevance but for the evaluation of their quality. This investigation might hopefully be helpful for further studies considering stent deployment in patient-specific geometries, in particular regarding the generation of the most appropriate computational model.

AmniVis - a system for qualitative exploration of near-wall hemodynamics in cerebral aneurysms

The qualitative exploration of near‐wall hemodynamics in cerebral aneurysms provides important insights for risk assessment. For instance, a direct relation between complex flow patterns and aneurysm formation could be observed. Due to the high complexity of the underlying time‐dependent flow data, the exploration is challenging, in particular for medical researchers not familiar with such data. We present the AmniVis‐Explorer, a system that is designed for the preparation of a qualitative medical study. The provided features were developed in close collaboration with medical researchers involved in the study. This comprises methods for a purposeful selection of surface regions of interest and a novel approach to provide a 2D overview of flow patterns that are represented by streamlines at these regions. Furthermore, we present a specialized interface that supports binary classification of patterns and temporal exploration as well as methods for selection, highlighting and automatic 3D navigation to particular patterns. Based on eight representative datasets, we conducted informal interviews with two bord‐certified radiologists and a flow expert to evaluate the system. It was confirmed that the AmniVis‐Explorer allows for an easy selection, qualitative exploration and classification of near‐wall flow patterns that are represented by streamlines.

Long-term occlusion results with SILK flow diversion in 28 aneurysms: Do recanalizations occur during follow-up?

Background and purpose The purpose of this article is to report on the long-term success rates of Silk flow-diverter (FD) treatment in a multicenter prospective study for the treatment of complex aneurysms. Methods Between May 2008 and January 2011, all consecutive patients featuring complex intracranial aneurysms eligible for FD treatment with the Silk in three neurovascular centers were included. Clinical and imaging data were assessed during hospitalization and follow-up. Results Five patients were initially asymptomatic, 20 patients showed various neurological symptoms. Twenty-eight FDs were implanted in 25 patients treating 28 aneurysms. The immediate procedure-related morbidity was 8% (two of 25), mortality 0%. One procedure-related death was observed during follow-up (in-stent thrombosis). Compared to the immediate result nearly two of three aneurysms improved during follow-up; all angiographically confirmed inflow changes took place within six months after treatment. Final anatomic outcome in 24 aneurysms of 22 patients comprised 14 (59%) with complete occlusion, seven (29%) with a neck remnant, two (8%) with residual filling <50%, none with residual filling >50% and one (4%) unchanged in comparison to its pretreatment status. Postinterventional recanalizations were seen in three of 13 (23%) aneurysms treated with FD alone; none were observed in 15 aneurysms treated with adjunctive coiling. Conclusion Anatomic presentation and location are key for successful FD treatment. The rate of successful occlusion increases during follow-up. Postinterventional monitoring for at least six months is paramount, as anatomic outcome is not reliably predictable and recanalizations may occur in initially completely occluded aneurysms.

Bipolar radiofrequency ablation of spinal tumors: predictability, safety and outcome

BACKGROUND Bone metastases are often the cause of tumor-associated pain and reduction of quality of life. For patients that cannot be treated by surgery, a local minimally invasive therapy such as radiofrequency ablation can be a useful option. In cases in which tumorous masses are adjacent to vulnerable structures, the monopolar radiofrequency can cause severe neuronal damage because of the unpredictability of current flow. PURPOSE The aim of this study is to show that the bipolar radiofrequency ablation provides an opportunity to safely treat such spinal lesions because of precise predictability of the emerging ablation zone. STUDY DESIGN Prospective cohort study of 36 patients undergoing treatment at a single institution. PATIENT SAMPLE Thirty-six patients in advanced tumor stage with primary or secondary tumor involvement of spine undergoing radiofrequency ablation. OUTCOME MEASURES Prediction of emerging ablation zone. Clinical outcome of treated patients. METHODS X-ray-controlled treatment of 39 lesions by bipolar radiofrequency ablation. Magnetic resonance imaging was performed pre- and postinterventionally. Patients were observed clinically during their postinterventional stay. RESULTS The extent of the ablation zones was predictable to the millimeter because it did not cross the peri-interventional planned dorsal and ventral boundaries in any case. No complications were observed. CONCLUSIONS Ablation of tumorous masses adjacent to vulnerable structures is feasible and predictable by using the bipolar radiofrequency ablation. Damage of neuronal structures can be avoided through precise prediction of the ablation area.