Sylvia Saalfeld

Does the DSA reconstruction kernel affect hemodynamic predictions in intracranial aneurysms? An analysis of geometry and blood flow variations

Background Computational fluid dynamics (CFD) blood flow predictions in intracranial aneurysms promise great potential to reveal patient-specific flow structures. Since the workflow from image acquisition to the final result includes various processing steps, quantifications of the individual introduced potential error sources are required. Methods Three-dimensional (3D) reconstruction of the acquired imaging data as input to 3D model generation was evaluated. Six different reconstruction modes for 3D digital subtraction angiography (DSA) acquisitions were applied to eight patient-specific aneurysms. Segmentations were extracted to compare the 3D luminal surfaces. Time-dependent CFD simulations were carried out in all 48 configurations to assess the velocity and wall shear stress (WSS) variability due to the choice of reconstruction kernel. Results All kernels yielded good segmentation agreement in the parent artery; deviations of the luminal surface were present at the aneurysm neck (up to 34.18%) and in distal or perforating arteries. Observations included pseudostenoses as well as noisy surfaces, depending on the selected reconstruction kernel. Consequently, the hemodynamic predictions show a mean SD of 11.09% for the aneurysm neck inflow rate, 5.07% for the centerline-based velocity magnitude, and 17.83%/9.53% for the mean/max aneurysmal WSS, respectively. In particular, vessel sections distal to the aneurysms yielded stronger variations of the CFD values. Conclusions The choice of reconstruction kernel for DSA data influences the segmentation result, especially for small arteries. Therefore, if precise morphology measurements or blood flow descriptions are desired, a specific reconstruction setting is required. Furthermore, research groups should be encouraged to denominate the kernel types used in future hemodynamic studies.

Semiautomatic neck curve reconstruction for intracranial aneurysm rupture risk assessment based on morphological parameters

PurposeMorphological parameters of intracranial aneurysms (IAs) are well established for rupture risk assessment. However, a manual measurement is error-prone, not reproducible and cumbersome. For an automatic extraction of morphological parameters, a 3D neck curve reconstruction approach to delineate the aneurysm from the parent vessel is required.MethodsWe present a 3D semiautomatic aneurysm neck curve reconstruction for the automatic extraction of morphological parameters which was developed and evaluated with an experienced neuroradiologist. We calculate common parameters from the literature and include two novel angle-based parameters: the characteristic dome point angle and the angle difference of base points.ResultsWe applied our method to 100 IAs acquired with rotational angiography in clinical routine. For validation, we compared our approach to manual segmentations yielding highly significant correlations. We analyzed 95 of these datasets regarding rupture state. Statistically significant differences were found in ruptured and unruptured groups for maximum diameter, maximum height, aspect ratio and the characteristic dome point angle. These parameters were also found to statistically significantly correlate with each other.ConclusionsThe new 3D neck curve reconstruction provides robust results for all datasets. The reproducibility depends on the vessel tree centerline and the user input for the initial dome point and parameters characterizing the aneurysm neck region. The characteristic dome point angle as a new metric regarding rupture risk assessment can be extracted. It requires less computational effort than the complete neck curve reconstruction.

Guidelines for Quantitative Evaluation of Medical Visualizations on the Example of 3D Aneurysm Surface Comparisons

Medical visualizations are highly adapted to a specific medical application scenario. Therefore, many researchers conduct qualitative evaluations with a low number of physicians or medical experts to assess the benefits of their visualization technique. Although this type of research has advantages, it is difficult to reproduce and can be subjectively biased. This makes it problematic to quantify the benefits of a new visualization technique. Quantitative evaluation can objectify research and help bringing new visualization techniques into clinical practice. To support researchers, we present guidelines to quantitatively evaluate medical visualizations, considering specific characteristics and difficulties. We demonstrate the adaptation of these guidelines on the example of comparative aneurysm surface visualizations. We developed three visualization techniques to compare aneurysm volumes. The visualization techniques depict two similar, but not identical aneurysm surface meshes. In a user study with 34 participants and five aneurysm data sets, we assessed objective measures (accuracy and required time) and subjective ratings (suitability and likeability). The provided guidelines and presentation of different stages of the evaluation allow for an easy adaptation to other application areas of medical visualization.

Virtual stenting of intracranial aneurysms: A pilot study for the prediction of treatment success based on hemodynamic simulations

Endovascular treatment of intracranial aneurysms using flow-diverting devices has revolutionized the treatment of large and complex lesions due to its minimally invasive nature and potential clinical outcomes. However, incomplete or delayed occlusion and persistent intracranial aneurysm growth are still an issue for up to one-third of the patients. We evaluated two patients with intracranial aneurysm located at the internal carotid artery who were treated with flow-diverting devices and had opposite outcomes. Both patients presented with similar aneurysms and were treated with the same device, but after a 1-year follow-up, one case presented with complete occlusion (Case 1) and the other required further treatment (Case 2). To reproduce the interventions, virtual stents were deployed and blood flow simulations were carried out using the respective patient-specific geometries. Afterward, hemodynamic metrics such as aneurysmal inflow reduction, wall shear stresses, oscillatory shear, and inflow concentration indices were quantified. The hemodynamic simulations reveal that for both cases, the neck inflow was clearly reduced due to the therapy (Case 1: 19%, Case 2: 35%). In addition, relevant hemodynamic parameters such as time-averaged wall shear stress (Case 1: 35.6%, Case 2: 57%) and oscillatory shear (Case 1: 33.1%, Case 2: 26.7%) were decreased considerably. However, although stronger relative reductions occurred in the unsuccessful case, the absolute flow values in the successful case were approximately halved. The findings demonstrate that a high relative effect of endovascular devices is not necessarily associated with the desired treatment outcome. Instead, it appears that a successful intracranial aneurysm therapy requires a certain patient-specific inflow threshold.

Fluid-structure interaction in intracranial vessel walls: The role of patient-specific wall thickness

Abstract Computational Fluid Dynamics studies try to support physicians during therapy planning of intracranial aneurysms. However, multiple assumptions (e.g. rigid vessel walls) are required leading to a sparse acceptance of numerical approaches within the medical community. This study incorporates multiple fluid-structural simulations for an intracranial basilar artery bifurcation. Based on a patient-specific dataset, which was acquired using optical coherence tomography, minimum, mean, maximum, and diameter-dependent thicknesses were generated and compared w.r.t. hemodynamic and wall stress parameters. The comparison of different wall thickness models revealed a strong variability among the analyzed parameters depending on the corresponding assumption. Using the patient-specific configuration as a reference, constant thicknesses lead to differences of up to 100 % in the mean wall stresses. Even the diameter-dependent thickness results in deviations of 32 %, demonstrating the wide variability of computational predictions due to inaccurate assumptions. The findings of this study highlight the importance of geometry reconstruction including accurate wall thickness reproduction for fluid-structure simulations. Patient-specific wall thickness seems to be out of alternatives regarding the realistic prediction of wall stress distributions.

Generation and Visual Exploration of Medical Flow Data: Survey, Research Trends and Future Challenges: Medical Flow Visualization

Simulations and measurements of blood and airflow inside the human circulatory and respiratory system play an increasingly important role in personalized medicine for prevention, diagnosis and treatment of diseases. This survey focuses on three main application areas. (1) Computational fluid dynamics (CFD) simulations of blood flow in cerebral aneurysms assist in predicting the outcome of this pathologic process and of therapeutic interventions. (2) CFD simulations of nasal airflow allow for investigating the effects of obstructions and deformities and provide therapy decision support. (3) 4D phase‐contrast (4D PC) magnetic resonance imaging of aortic haemodynamics supports the diagnosis of various vascular and valve pathologies as well as their treatment. An investigation of the complex and often dynamic simulation and measurement data requires the coupling of sophisticated visualization, interaction and data analysis techniques. In this paper, we survey the large body of work that has been conducted within this realm. We extend previous surveys by incorporating nasal airflow, addressing the joint investigation of blood flow and vessel wall properties and providing a more fine‐granular taxonomy of the existing techniques. From the survey, we extract major research trends and identify open problems and future challenges. The survey is intended for researchers interested in medical flow but also more general, in the combined visualization of physiology and anatomy, the extraction of features from flow field data and feature‐based visualization, the visual comparison of different simulation results and the interactive visual analysis of the flow field and derived characteristics.

Explorative Blood Flow Visualization using Dynamic Line Filtering based on Surface Features

Rupture risk assessment is a key to devise patient‐specific treatment plans of cerebral aneurysms. To understand and predict the development of aneurysms and other vascular diseases over time, both hemodynamic flow patterns and their effect on the vessel surface need to be analyzed. Flow structures close to the vessel wall often correlate directly with local changes in surface parameters, such as pressure or wall shear stress. Yet, in many existing applications, the analyses of flow and surface features are either somewhat detached from one another or only globally available. Especially for the identification of specific blood flow characteristics that cause local startling parameters on the vessel surface, like elevated pressure values, an interactive analysis tool is missing.

Impact of Gradual Vascular Deformations on the Intra-aneurysmal Hemodynamics

The treatment of intracranial aneurysms based on stentassisted coiling often leads to local vascular deformations. Patient-specific data of an aneurysm in the pre interventional and follow-up state is used to interpolate intermediate vessel-aneurysm configurations. Computational Fluid Dynamics simulations are performed in order to quantify the effect of vessel deformation on the blood flow. Results reveal gradual changes in the blood flow patterns shifting the load on the aneurysm wall from the dome to the neck region. Based on this novel concept, it is possible to virtually evaluate how different types of stents can improve or impair the treatment goal of reducing the intra-aneurysmal blood flow.

Two-Step Trajectory Visualization for Robot-Assisted Spine Radiofrequency Ablations

Radiofrequency Ablations (RFAs) can be employed for the treatment of spine metastases. Instruments are therefor inserted through the vertebra’s pedicle into cancerous tissue within the vertebral body. This requires high precision during interventions. We present a two-step method to increase risk awareness during intervention planning and execution of manual and robot-assisted spine RFAs. Three medical experts evaluated our method and stated that it yields two advantages: First, improved visualizations for manual interventions and second, increased safety in hand-guided, robot-assisted setups.

Combining Pseudo Chroma Depth Enhancement and Parameter Mapping for Vascular Surface Models

The presence of depth cues in a visualization can be a great aid in understanding the structure and topology of a vessel tree. Pseudo Chromadepth is a well-known technique for enhancing depth perception in vascular 3D models. Since it strongly relies on the color channel to convey its depth cues, it is traditionally not suited for combined visualizations comprising color-encoded surface parameters. In this paper, we present and evaluate the use of a modified form of Pseudo Chromadepth that supports displaying additional surface parameters using the color channel while still increasing depth perception. This technique has been designed for the visualization of cerebral aneurysm models. We have combined a discretized color scale to visualize the surface parameter with the Pseudo Chromadepth color scale to convey depth using a Fresnel-inspired blending mask. To evaluate our approach, we have conducted two consecutive studies. The first was performed with 104 participants from the general public and the second with eleven experts in the fields of medical engineering and flow simulation. These studies show that Pseudo Chromadepth can be used in conjunction with color-encoded surface attributes to support depth perception as long as the color scale is chosen appropriately.