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Enhanced 4D Flow MRI-Based CFD with Adaptive Mesh Refinement for Flow Dynamics Assessment in Coarctation of the Aorta

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Abstract

4D Flow MRI is a diagnostic tool that can visualize and quantify patient-specific hemodynamics and help interventionalists optimize treatment strategies for repairing coarctation of the aorta (COA). Despite recent developments in 4D Flow MRI, shortcomings include phase-offset errors, limited spatiotemporal resolution, aliasing, inaccuracies due to slow aneurysmal flows, and distortion of images due to metallic artifact from vascular stents. To address these limitations, we developed a framework utilizing Computational Fluid Dynamics (CFD) with Adaptive Mesh Refinement (AMR) that enhances 4D Flow MRI visualization/quantification. We applied this framework to five pediatric patients with COA, providing in-vivo and in-silico datasets, pre- and post-intervention. These two data sets were compared and showed that CFD flow rates were within 9.6% of 4D Flow MRI, which is within a clinically acceptable range. CFD simulated slow aneurysmal flow, which MRI failed to capture due to high relative velocity encoding (Venc). CFD successfully predicted in-stent blood flow, which was not visible in the in-vivo data due to susceptibility artifact. AMR improved spatial resolution by factors of 101 to 103 and temporal resolution four-fold. This computational framework has strong potential to optimize visualization/quantification of aneurysmal and in-stent flows, improve spatiotemporal resolution, and assess hemodynamic efficiency post-COA treatment.

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Abbreviations

COA:

Coarctation of the aorta

CFD:

Computational fluid dynamics

AMR:

Adaptive mesh refinement

Venc :

Velocity encoding

PC-MRA:

Phase-contrast magnetic resonance angiography

CE-MRA:

Contrast-enhanced magnetic resonance angiography

CTA:

Computed tomography angiography

BC:

Boundary condition

\({q}^{\text{BCA}}\) :

Fractional volumetric flow rate in brachiocephalic artery

\({q}^{\text{LCC}}\) :

Fractional volumetric flow rate in left common carotid artery

\({q}^{\text{LS}}\) :

Fractional volumetric flow rate in left subclavian artery

\({q}^{\text{Desc}}\) :

Fractional volumetric flow rate in descending thoracic aorta

\(\Delta q\) :

Maximum absolute difference in fractional volumetric flow rates from 4D flow MRI and CFD among outlets

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Acknowledgments

Funding was provided by the American Heart Association (Grant No. 19TPA34850066). GE Healthcare, which provides research support to the University of Wisconsin. This research was performed using the compute resources and assistance of the UW-Madison Center For High Throughput Computing (CHTC) in the Department of Computer Sciences. The CHTC is supported by UW-Madison, the Advanced Computing Initiative, the Wisconsin Alumni Research Foundation, the Wisconsin Institutes for Discovery, and the National Science Foundation, and is an active member of the OSG Consortium, which is supported by the National Science Foundation and the U.S. Department of Energy's Office of Science.

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of Wisconsin-Madison, 1111 Highland Ave, Room 2476 WIMR II, Madison, WI, 53705, USA

    Labib Shahid, James Rice & Alejandro Roldán-Alzate

  2. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Haben Berhane & Michael Markl

  3. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA

    Haben Berhane & Michael Markl

  4. Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Cynthia Rigsby, Joshua Robinson & Lindsay Griffin

  5. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA

    Alejandro Roldán-Alzate

  6. Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA

    Alejandro Roldán-Alzate

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  1. Labib Shahid
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Correspondence to Labib Shahid.

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Shahid, L., Rice, J., Berhane, H. et al. Enhanced 4D Flow MRI-Based CFD with Adaptive Mesh Refinement for Flow Dynamics Assessment in Coarctation of the Aorta. Ann Biomed Eng 50, 1001–1016 (2022). https://doi.org/10.1007/s10439-022-02980-7

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