Atlas-Based Reduced Models of Blood Flows for Fast Patient-Specific Simulations

The original publication is available at www.springerlink.com.International audienceModel-based interpretation of the complex clinical data now available (shape, motion, flow) can provide quantitative information for diagnosis as well as predictions. However such models can be extremely time consuming, which does not always fit with the clinical time constraints. The aim of this work is to propose a model reduction technique to perform faster patient-specific simulations with prior knowledge built from simulations on an average anatomy. Rather than simulating a full fluid problem on individual patients, we create a representative `template' of the artery shape. A full flow simulation is carried out only on this template, and a reduced model is built from the results. Then this reduced model can be transported to the individual geometries, allowing faster computational analysis. % Here we propose a preliminary validation of this idea. A well-posed framework based on currents representation of shapes is used to create an unbiased template of the pulmonary artery for 4 patients with Tetralogy of Fallot. Then, a reduced computational fluid dynamics model is built on this template. Finally, we demonstrate that this reduced model can represent a specific patient simulation

Left Ventricular Trabeculations Decrease the Wall Shear Stress and Increase the Intra-Ventricular Pressure Drop in CFD Simulations

The aim of the present study is to characterize the hemodynamics of left ventricular (LV) geometries to examine the impact of trabeculae and papillary muscles (PMs) on blood flow using high performance computing (HPC). Five pairs of detailed and smoothed LV endocardium models were reconstructed from high-resolution magnetic resonance images (MRI) of ex-vivo human hearts. The detailed model of one LV pair is characterized only by the PMs and few big trabeculae, to represent state of art level of endocardial detail. The other four detailed models obtained include instead endocardial structures measuring ≥1 mm2 in cross-sectional area. The geometrical characterizations were done using computational fluid dynamics (CFD) simulations with rigid walls and both constant and transient flow inputs on the detailed and smoothed models for comparison. These simulations do not represent a clinical or physiological scenario, but a characterization of the interaction of endocardial structures with blood flow. Steady flow simulations were employed to quantify the pressure drop between the inlet and the outlet of the LVs and the wall shear stress (WSS). Coherent structures were analyzed using the Q-criterion for both constant and transient flow inputs. Our results show that trabeculae and PMs increase the intra-ventricular pressure drop, reduce the WSS and disrupt the dominant single vortex, usually present in the smoothed-endocardium models, generating secondary small vortices. Given that obtaining high resolution anatomical detail is challenging in-vivo, we propose that the effect of trabeculations can be incorporated into smoothed ventricular geometries by adding a porous layer along the LV endocardial wall. Results show that a porous layer of a thickness of 1.2·10−2 m with a porosity of 20 kg/m2 on the smoothed-endocardium ventricle models approximates the pressure drops, vorticities and WSS observed in the detailed models.This paper has been partially funded by CompBioMed project, under H2020-EU.1.4.1.3 European Union’s Horizon 2020 research and innovation programme, grant agreement n◦ 675451. FS is supported by a grant from Severo Ochoa (n◦ SEV-2015-0493-16-4), Spain. CB is supported by a grant from the Fundació LaMarató de TV3 (n◦ 20154031), Spain. TI and PI are supported by the Institute of Engineering in Medicine, USA, and the Lillehei Heart Institute, USA.Peer ReviewedPostprint (published version

Fast simulations of patient-specific haemodynamics of coronary artery bypass grafts based on a POD-Galerkin method and a vascular shape parametrization

In this work a reduced-order computational framework for the study of haemodynamics in three-dimensional patient-specific configurations of coronary artery bypass grafts dealing with a wide range of scenarios is proposed. We combine several efficient algorithms to face at the same time both the geometrical complexity involved in the description of the vascular network and the huge computational cost entailed by time dependent patient-specific flow simulations. Medical imaging procedures allow to reconstruct patient-specific configurations from clinical data. A centerlines-based parametrization is proposed to efficiently handle geometrical variations. POD-Galerkin reduced-order models are employed to cut down large computational costs. This computational framework allows to characterize blood flows for different physical and geometrical variations relevant in the clinical practice, such as stenosis factors and anastomosis variations, in a rapid and reliable way. Several numerical results are discussed, highlighting the computational performance of the proposed framework, as well as its capability to carry out sensitivity analysis studies, so far out of reach. In particular, a reduced-order simulation takes only a few minutes to run, resulting in computational savings of 99% of CPU time with respect to the full-order discretization. Moreover, the error between full-order and reduced-order solutions is also studied, and it is numerically found to be less than 1% for reduced-order solutions obtained with just O(100) online degrees of freedom. (C) 2016 Elsevier Inc. All rights reserved

Group-wise Construction of Reduced Models for Understanding and Characterization of Pulmonary Blood Flows from Medical Images

International audience3D computational fluid dynamics (CFD) in patient-specific geometries provides complementary insights to clinical imaging, to better understand how heart disease, and the side effects of treating heart disease, affect and are affected by hemodynamics. This information can be useful in treatment planning for designing artificial devices that are subject to stress and pressure from blood flow. Yet, these simulations remain relatively costly within a clinical context. The aim of this work is to reduce the complexity of patient-specific simulations by combining image analysis, computational fluid dynamics and model order reduction techniques. The proposed method makes use of a reference geometry estimated as an average of the population, within an efficient statistical framework based on the currents representation of shapes. Snapshots of blood flow simulations performed in the reference geometry are used to build a POD (Proper Orthogonal Decomposition) basis, which can then be mapped on new patients to perform reduced order blood flow simulations with patient specific boundary conditions. This approach is applied to a data-set of 17 tetralogy of Fallot patients to simulate blood flow through the pulmonary artery under normal (healthy or synthetic valves with almost no backflow) and pathological (leaky or absent valve with backflow) conditions to better understand the impact of regurgitated blood on pressure and velocity at the outflow tracts. The model reduction approach is further tested by performing patient simulations under exercise and varying degrees of pathophysiological conditions based on reduction of reference solutions (rest and medium backflow conditions respectively)

Advances in geometrical parametrization and reduced order models and methods for computational fluid dynamics problems in applied sciences and engineering: overview and perspectives

Several problems in applied sciences and engineering require reduction techniques in order to allow computational tools to be employed in the daily practice, especially in iterative procedures such as optimization or sensitivity analysis. Reduced order methods need to face increasingly complex problems in computational mechanics, especially into a multiphysics setting. Several issues should be faced: stability of the approximation, efficient treatment of nonlinearities, uniqueness or possible bifurcations of the state solutions, proper coupling between fields, as well as offline-online computing, computational savings and certification of errors as measure of accuracy. Moreover, efficient geometrical parametrization techniques should be devised to efficiently face shape optimization problems, as well as shape reconstruction and shape assimilation problems. A related aspect deals with the management of parametrized interfaces in multiphysics problems, such as fluid-structure interaction problems, and also a domain decomposition based approach for complex parametrized networks. We present some illustrative industrial and biomedical problems as examples of recent advances on methodological developments. \ua9 The author

Advances in geometrical parametrization and reduced order models and methods for computational fluid dynamics problems in applied sciences and engineering: Overview and perspectives

Several problems in applied sciences and engineering require reduction techniques in order to allow computational tools to be employed in the daily practice, especially in iterative procedures such as optimization or sensitivity analysis. Reduced order methods need to face increasingly complex problems in computational mechanics, especially into a multiphysics setting. Several issues should be faced: stability of the approximation, efficient treatment of nonlinearities, uniqueness or possible bifurcations of the state solutions, proper coupling between fields, as well as offline-online computing, computational savings and certification of errors as measure of accuracy. Moreover, efficient geometrical parametrization techniques should be devised to efficiently face shape optimization problems, as well as shape reconstruction and shape assimilation problems. A related aspect deals with the management of parametrized interfaces in multiphysics problems, such as fluid-structure interaction problems, and also a domain decomposition based approach for complex parametrized networks. We present some illustrative industrial and biomedical problems as examples of recent advances on methodological developments

Inferring Geodesic Cerebrovascular Graphs: Image Processing, Topological Alignment and Biomarkers Extraction

A vectorial representation of the vascular network that embodies quantitative features - location, direction, scale, and bifurcations - has many potential neuro-vascular applications. Patient-specific models support computer-assisted surgical procedures in neurovascular interventions, while analyses on multiple subjects are essential for group-level studies on which clinical prediction and therapeutic inference ultimately depend. This first motivated the development of a variety of methods to segment the cerebrovascular system. Nonetheless, a number of limitations, ranging from data-driven inhomogeneities, the anatomical intra- and inter-subject variability, the lack of exhaustive ground-truth, the need for operator-dependent processing pipelines, and the highly non-linear vascular domain, still make the automatic inference of the cerebrovascular topology an open problem. In this thesis, brain vessels’ topology is inferred by focusing on their connectedness. With a novel framework, the brain vasculature is recovered from 3D angiographies by solving a connectivity-optimised anisotropic level-set over a voxel-wise tensor field representing the orientation of the underlying vasculature. Assuming vessels joining by minimal paths, a connectivity paradigm is formulated to automatically determine the vascular topology as an over-connected geodesic graph. Ultimately, deep-brain vascular structures are extracted with geodesic minimum spanning trees. The inferred topologies are then aligned with similar ones for labelling and propagating information over a non-linear vectorial domain, where the branching pattern of a set of vessels transcends a subject-specific quantized grid. Using a multi-source embedding of a vascular graph, the pairwise registration of topologies is performed with the state-of-the-art graph matching techniques employed in computer vision. Functional biomarkers are determined over the neurovascular graphs with two complementary approaches. Efficient approximations of blood flow and pressure drop account for autoregulation and compensation mechanisms in the whole network in presence of perturbations, using lumped-parameters analog-equivalents from clinical angiographies. Also, a localised NURBS-based parametrisation of bifurcations is introduced to model fluid-solid interactions by means of hemodynamic simulations using an isogeometric analysis framework, where both geometry and solution profile at the interface share the same homogeneous domain. Experimental results on synthetic and clinical angiographies validated the proposed formulations. Perspectives and future works are discussed for the group-wise alignment of cerebrovascular topologies over a population, towards defining cerebrovascular atlases, and for further topological optimisation strategies and risk prediction models for therapeutic inference. Most of the algorithms presented in this work are available as part of the open-source package VTrails

Data-driven reduced-order modelling for blood flow simulations with geometry-informed snapshots

Parametric reduced-order modelling often serves as a surrogate method for hemodynamics simulations to improve the computational efficiency in many-query scenarios or to perform real-time simulations. However, the snapshots of the method require to be collected from the same discretisation, which is a straightforward process for physical parameters, but becomes challenging for geometrical problems, especially for those domains featuring unparameterised and unique shapes, e.g. patient-specific geometries. In this work, a data-driven surrogate model is proposed for the efficient prediction of blood flow simulations on similar but distinct domains. The proposed surrogate model leverages group surface registration to parameterise those shapes and formulates corresponding hemodynamics information into geometry-informed snapshots by the diffeomorphisms constructed between a reference domain and original domains. A non-intrusive reduced-order model for geometrical parameters is subsequently constructed using proper orthogonal decomposition, and a radial basis function interpolator is trained for predicting the reduced coefficients of the reduced-order model based on compressed geometrical parameters of the shape. Two examples of blood flowing through a stenosis and a bifurcation are presented and analysed. The proposed surrogate model demonstrates its accuracy and efficiency in hemodynamics prediction and shows its potential application toward real-time simulation or uncertainty quantification for complex patient-specific scenarios

Patient-specific CFD models for intraventricular flow analysis from 3D ultrasound imaging : comparison of three clinical cases

Background: As the intracardiac flow field is affected by changes in shape and motility of the heart, intraventricular flow features can provide diagnostic indications. Ventricular flow patterns differ depending on the cardiac condition and the exploration of different clinical cases can provide insights into how flow fields alter in different pathologies. Methods: In this study, we applied a patient-specific computational fluid dynamics model of the left ventricle and mitral valve, with prescribed moving boundaries based on transesophageal ultrasound images for three cardiac pathologies, to verify the abnormal flow patterns in impaired hearts. One case (P1) had normal ejection fraction but low stroke volume and cardiac output, P2 showed low stroke volume and reduced ejection fraction, P3 had a dilated ventricle and reduced ejection fraction. Results: The shape of the ventricle and mitral valve, together with the pathology influence the flow field in the left ventricle, leading to distinct flow features. Of particular interest is the pattern of the vortex formation and evolution, influenced by the valvular orifice and the ventricular shape. The base-to-apex pressure difference of maximum 2 mmHg is consistent with reported data. Conclusion: We used a CFD model with prescribed boundary motion to describe the intraventricular flow field in three patients with impaired diastolic function. The calculated intraventricular flow dynamics are consistent with the diagnostic patient records and highlight the differences between the different cases. The integration of clinical images and computational techniques, therefore, allows for a deeper investigation intraventricular hemodynamics in patho-physiology. (C) 2016 Elsevier Ltd. All rights reserved