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- Andersson, Magnus, 1983-
(författare)
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Turbulence Descriptors in Arterial Flows : Patient-Specific Computational Hemodynamics
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- At this very moment, there are literally millions of people who suffer from various types of cardiovascular diseases (CVDs), many of whom will experience reduced quality of life or premature lift expectancy. The detailed underlying pathogenic processes behind many of these disorders are not well understood, but were abnormal dynamics of the blood flow (hemodynamics) are believed to play an important role, especially atypical flow-mediated frictional forces on the intraluminal wall (i.e. the wall shear stress, WSS). Under normal physiological conditions, the flow is relatively stable and regular (smooth and laminar), which helps to maintain critical vascular functions. When these flows encounter various unfavorable anatomical obstructions, the flow can become highly unstable and irregular (turbulent), giving rise to abnormal fluctuating hemodynamic forces, which increase the bloodstream pressure losses, can damage the cells within the blood, as well as impair essential structural and functional regulatory mechanisms. Over a prolonged time, these disturbed flow conditions may promote severe pathological responses and are therefore essential to foresee as early as possible.Clinical measurements of blood flow characteristics are often performed non-invasively by modalities such as ultrasound and magnetic resonance imaging (MRI). High-fidelity MRI techniques may be used to attain a general view of the overall large-scale flow features in the heart and larger vessels but cannot be used for estimating small-scale flow variations nor capture the WSS characteristics. Since the era of modern computers, fluid motion can now also be predicted by computational fluid dynamics (CFD)simulations, which can provide discrete mathematical approximations of the flow field with much higher details (resolution) and accuracy compared to other modalities. CFD simulations rely on the same fundamental principles as weather forecasts, the physical laws of fluid motion, and thus can not only be used to assess the current flow state but also to predict (foresee) important outcome scenarios in e.g. intervention planning. To enable blood flow simulations within certain cardiovascular segments, these CFD models are usually reconstructed from MRI-based anatomical and flow image-data. Today, patient-specific computational hemodynamics are essentially only performed within the research field, where much emphasis is dedicated towards understanding normal/abnormal blood flow physiology, developing better individual-based diagnostics/treatments, and evaluating the results reliability/generality in order to approach clinical applicability.In this thesis, advanced CFD methods were adopted to simulate realistic patient-specific turbulent hemodynamics in constricted arteries reconstructed from MRI data. The main focus was to investigate novel, comprehensive ways to characterize these abnormal flow conditions, in the pursuit of better clinical decision-making tools; from more in-depth analyzes of various turbulence-related tensor characteristics to descriptors that evaluate the hemodynamics more globally in the domain. Results from the studies in this thesis suggest that these turbulence descriptors can be useful to: i) target cardiovascular sites prone to specific turbulence characteristics, both in the bulk flow and on the intraluminal wall, ii) provide a more extensive view of the general flow severity within malformed vascular regions, and iii) evaluated and potentially improve cardiovascular modeling strategies and MRI-measured turbulence data.The benefit of these descriptors is that they all, in principle, can be measured by different MRI procedures, making them more accessible from a clinical perspective. Although the significance of these suggested flow-mediated phenotypes has not yet been evaluated clinically, this work opens many doors of opportunities for making more thorough and longitudinal patient-specific studies, including large cohorts of patients with various CVDs susceptible to turbulent-like conditions, as well as performing more in-depth CFD-MRI validation analyzes.
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| 2. |
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| 3. |
- Casas Garcia, Belén, 1985-
(författare)
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Towards Personalized Models of the Cardiovascular System Using 4D Flow MRI
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Current diagnostic tools for assessing cardiovascular disease mostly focus on measuring a given biomarker at a specific spatial location where an abnormality is suspected. However, as a result of the dynamic and complex nature of the cardiovascular system, the analysis of isolated biomarkers is generally not sufficient to characterize the pathological mechanisms behind a disease. Model-based approaches that integrate the mechanisms through which different components interact, and present possibilities for system-level analyses, give us a better picture of a patient’s overall health status.One of the main goals of cardiovascular modelling is the development of personalized models based on clinical measurements. Recent years have seen remarkable advances in medical imaging and the use of personalized models is slowly becoming a reality. Modern imaging techniques can provide an unprecedented amount of anatomical and functional information about the heart and vessels. In this context, three-dimensional, three-directional, cine phase-contrast (PC) magnetic resonance imaging (MRI), commonly referred to as 4D Flow MRI, arises as a powerful tool for creating personalized models. 4D Flow MRI enables the measurement of time-resolved velocity information with volumetric coverage. Besides providing a rich dataset within a single acquisition, the technique permits retrospective analysis of the data at any location within the acquired volume.This thesis focuses on improving subject-specific assessment of cardiovascular function through model-based analysis of 4D Flow MRI data. By using computational models, we aimed to provide mechanistic explanations of the underlying physiological processes, derive novel or improved hemodynamic markers, and estimate quantities that typically require invasive measurements. Paper I presents an evaluation of current markers of stenosis severity using advanced models to simulate flow through a stenosis. Paper II presents a framework to personalize a reduced-order, mechanistic model of the cardiovascular system using exclusively non-invasive measurements, including 4D Flow MRI data. The modelling approach can unravel a number of clinically relevant parameters from the input data, including those representing the contraction and relaxation patterns of the left ventricle, and provide estimations of the pressure-volume loop. In Paper III, this framework is applied to study cardiovascular function at rest and during stress conditions, and the capability of the model to infer load-independent measures of heart function based on the imaging data is demonstrated. Paper IV focuses on evaluating the reliability of the model parameters as a step towards translation of the model to the clinic.
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| 4. |
- Gupta, Vikas, et al.
(författare)
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Automated three-dimensional tracking of the left ventricular myocardium in time-resolved and dose-modulated cardiac CT images using deformable image registration
- 2018
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Ingår i: Journal of Cardiovascular Computed Tomography. - : Elsevier. - 1934-5925. ; 12:2, s. 139-148
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Tidskriftsartikel (refereegranskat)abstract
- Background Assessment of myocardial deformation from time-resolved cardiac computed tomography (4D CT) would augment the already available functional information from such an examination without incurring any additional costs. A deformable image registration (DIR) based approach is proposed to allow fast and automatic myocardial tracking in clinical 4D CT images.Methods Left ventricular myocardial tissue displacement through a cardiac cycle was tracked using a B-spline transformation based DIR. Gradient of such displacements allowed Lagrangian strain estimation with respect to end-diastole in clinical 4D CT data from ten subjects with suspected coronary artery disease. Dice similarity coefficient (DSC), point-to-curve error (PTC), and tracking error were used to assess the tracking accuracy. Wilcoxon signed rank test provided significance of tracking errors. Topology preservation was verified using Jacobian of the deformation. Reliability of estimated strains and torsion (normalized twist angle) was tested in subjects with normal function by comparing them with normal strain in the literature.Results Comparison with manual tracking showed high accuracy (DSC: 0.99± 0.05; PTC: 0.56mm± 0.47 mm) and resulted in determinant(Jacobian) > 0 for all subjects, indicating preservation of topology. Average radial (0.13 mm), angular (0.64) and longitudinal (0.10 mm) tracking errors for the entire cohort were not significant (p > 0.9). For patients with normal function, average strain [circumferential, radial, longitudinal] and peak torsion estimates were: [-23.5%, 31.1%, −17.2%] and 7.22°, respectively. These estimates were in conformity with the reported normal ranges in the existing literature.Conclusions Accurate wall deformation tracking and subsequent strain estimation are feasible with the proposed method using only routine time-resolved 3D cardiac CT.
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| 5. |
- Lantz, Jonas, 1982-, et al.
(författare)
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Impact of prosthetic mitral valve orientation on the ventricular flow field : Comparison using patient-specific computational fluid dynamics
- 2021
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Ingår i: Journal of Biomechanics. - : Elsevier Science Ltd. - 0021-9290 .- 1873-2380. ; 116
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Tidskriftsartikel (refereegranskat)abstract
- Significant mitral valve regurgitation creates progressive adverse remodeling of the left ventricle (LV). Replacement of the failing valve with a prosthesis generally improves patient outcomes but leaves the patient with non-physiological intracardiac flow patterns that might contribute to their future risk of thrombus formation and embolism. It has been suggested that the angular orientation of the implanted valve might modify the postoperative distortion of the intraventricular flow field. In this study, we investigated the effect of prosthetic valve orientation on LV flow patterns by using heart geometry from a patient with LV dysfunction and a competent native mitral valve to calculate intracardiac flow fields with computational fluid dynamics (CFD). Results were validated using in vivo 4D Flow MRI. The computed flow fields were compared to calculations following virtual implantation of a mechanical heart valve oriented in four different angles to assess the effect of leaflet position. Flow patterns were visualized in longand short-axes and quantified with flow component analysis. In comparison to a native valve, valve implantation increased the proportion of the mitral inflow remaining in the basal region and further increased the residual volume in the apical area. Only slight changes due to valve orientation were observed. Using our numerical framework, we demonstrated quantitative changes in left ventricular blood flow due to prosthetic mitral replacement. This framework may be used to improve design of prosthetic heart valves and implantation procedures to minimize the potential for apical flow stasis, and potentially assist personalized treatment planning. (c) 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 6. |
- Lantz, Jonas, 1982-, et al.
(författare)
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Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations : Comparison with In Vivo 4D Flow MRI
- 2019
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Ingår i: Annals of Biomedical Engineering. - : Springer-Verlag New York. - 0090-6964 .- 1573-9686. ; 47:2, s. 413-424
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Tidskriftsartikel (refereegranskat)abstract
- Blood flow simulations are making their way into the clinic, and much attention is given to estimation of fractional flow reserve in coronary arteries. Intracardiac blood flow simulations also show promising results, and here the flow field is expected to depend on the pulmonary venous (PV) flow rates. In the absence of in vivo measurements, the distribution of the flow from the individual PVs is often unknown and typically assumed. Here, we performed intracardiac blood flow simulations based on time-resolved computed tomography on three patients, and investigated the effect of the distribution of PV flow rate on the flow field in the left atrium and ventricle. A design-of-experiment approach was used, where PV flow rates were varied in a systematic manner. In total 20 different simulations were performed per patient, and compared to in vivo 4D flow MRI measurements. Results were quantified by kinetic energy, mitral valve velocity profiles and root-mean-square errors of velocity. While large differences in atrial flow were found for varying PV inflow distributions, the effect on ventricular flow was negligible, due to a regularizing effect by mitral valve. Equal flow rate through all PVs most closely resembled in vivo measurements and is recommended in the absence of a priori knowledge.
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| 7. |
- Lantz, Jonas, 1982-, et al.
(författare)
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Intracardiac Flow at 4D CT : Comparison with 4D Flow MRI
- 2018
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Ingår i: Radiology. - Oak Brook, IL United States : Radiological Society of North America, Inc.. - 0033-8419 .- 1527-1315. ; 289:1, s. 51-58
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo investigate four-dimensional (4D) flow CT for the assessment of intracardiac blood flow patterns as compared with 4D flow MRI.Materials and MethodsThis prospective study acquired coronary CT angiography and 4D flow MRI data between February and December 2016 in a cohort of 12 participants (age range, 36–74 years; mean age, 57 years; seven men [age range, 36–74 years; mean age, 57 years] and five women [age range, 52–73 years; mean age, 64 years]). Flow simulations based solely on CT-derived cardiac anatomy were assessed together with 4D flow MRI measurements. Flow patterns, flow rates, stroke volume, kinetic energy, and flow components were quantified for both techniques and were compared by using linear regression.ResultsCardiac flow patterns obtained by using 4D flow CT were qualitatively similar to 4D flow MRI measurements, as graded by three independent observers. The Cohen κ score was used to assess intraobserver variability (0.83, 0.79, and 0.70) and a paired Wilcoxon rank-sum test showed no significant change (P > .05) between gradings. Peak flow rate and stroke volumes between 4D flow MRI measurements and 4D flow CT measurements had high correlation (r = 0.98 and r = 0.81, respectively; P < .05 for both). Integrated kinetic energy quantified at peak systole correlated well (r = 0.95, P < .05), while kinetic energy levels at early and late filling showed no correlation. Flow component analysis showed high correlation for the direct and residual components, respectively (r = 0.93, P < .05 and r = 0.87, P < .05), while the retained and delayed components showed no correlation.ConclusionFour-dimensional flow CT produced qualitatively and quantitatively similar intracardiac blood flow patterns compared with the current reference standard, four-dimensional flow MRI.
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| 8. |
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| 9. |
- Lantz, Jonas, 1982-
(författare)
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On Aortic Blood Flow Simulations : Scale-Resolved Image-Based CFD
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on modeling and simulation of the blood flow in the aorta, the largest artery in the human body. It is an accepted fact that abnormal biological and mechanical interactions between the blood flow and the vessel wall are involved in the genesis and progression of cardiovascular diseases. The transport of low-density lipoprotein into the wall has been linked to the initiation of atherosclerosis. The mechanical forces acting on the wall can impede the endothelial cell layer function, which normally acts as a barrier to harmful substances. The wall shear stress (WSS) affects endothelial cell function, and is a direct consequence of the flow field; steady laminar flows are generally considered atheroprotective, while the unsteady turbulent flow could contribute to atherogenesis. Quantification of regions with abnormal wall shear stress is therefore vital in order to understand the initiation and progression of atherosclerosis.However, flow forces such as WSS cannot today be measured with significant accuracy using present clinical measurement techniques. Instead, researches rely on image-based computational modeling and simulation. With the aid of advanced mathematical models it is possible to simulate the blood flow, vessel dynamics, and even biochemical reactions, enabling information and insights that are currently unavailable through other techniques. During the cardiac cycle, the normally laminar aortic blood flow can become unstable and undergo transition to turbulence, at least in pathological cases such as coarctation of the aorta where the vessel is locally narrowed. The coarctation results in the formation of a jet with a high velocity, which will create the transition to turbulent flow. The high velocity will also increase the forces on the vessel wall. Turbulence is generally very difficult to model, requiring advanced mathematical models in order to resolve the flow features. As the flow is highly dependent on geometry, patient-specific representations of the in vivo arterial walls are needed, in order to perform an accurate and reliable simulation. Scale-resolving flow simulations were used to compute the WSS on the aortic wall and resolve the turbulent scales in the complex flow field. In addition to WSS, the turbulent flow before and after surgical intervention in an aortic coarctation was assessed. Numerical results were compared to state-of-the-art magnetic resonance imaging measurements. The results agreed very well, suggesting that that the measurement technique is reliable and could be used as a complement to standard clinical procedures when evaluating the outcome of an intervention.The work described in the thesis deals with patient-specific flows, and is, when possible, validated with experimental measurements. The results provide new insights to turbulent aortic flows, and show that image-based computational modeling and simulation are now ready for clinical practice.
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| 10. |
- Lantz, Jonas, 1982-, et al.
(författare)
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Wall shear stress in an MRI-Based Subject-Specific Human Aorta Using Fluid-Structure Interaction
- 2010
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Ingår i: Proceedings of the ASME 2010 Summer Bioengineering Conference (SBC2010). - NY, USA : ASME. - 9780791844038 ; , s. 563-564
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Wall shear stress (WSS) is well established as an indicator of increased risk for development of atherosclerotic plaques, platelet activation and thrombus formation [1]. Prediction and simulation of the sites of wall shear stresses that are deemed dangerous before intervention would be of great aid to the surgeon. However, the geometries used for these types of simulations are often approximated to be rigid. To more accurately capture the flow and arterial wall response of a realistic human aorta, fluid-structure interaction (FSI) which allows movement of the wall, is needed. Hence, the pressure wave and its effect on the wall motion are resolved and enables a more physiological model as compared to a rigid wall case.
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