Abstract 3021: An Examination Of Emerging Techniques Forquantification Of Systemic-to-pulmonary Collateral Vessel Burden Using Imaging Modalities

Abstract

Introduction: The quantification of systemic-to-pulmonary collateral vessels (SPCs) and their effects on hemodynamics is a subjective standard that has been intriguing for physicians due to the implications they could have; in cases where there is significant collateral burden, occlusion of these SPCs may be desirable, though this can present with a risk of stroke due to errant embolization particles. No benchmark method of SPC flow assessment has been established. Quantitative analysis of systemic and pulmonary flow values is possible through the use of computational fluid dynamics (CFD). CFD models can provide advanced and accurate analysis of cardiovascular hemodynamics providing more information beyond routine imaging. Hypothesis: Current methods for quantifying SPC burden are inadequate and could be improved through the use of additional CFD analysis. Methods: A PubMed and Science Direct search was performed. Select inclusion and exclusion criteria were applied to search results. Results: The search resulted in a total of 155 unique articles. Of these, 94 articles were found to meet inclusion criteria, and 54 articles were settled on after reviewing articles for further exclusion criteria. Seven articles discussed the use of CT and catheterization for quantifying collateral burden while 43 described using MRI to provide flow values. Eight articles mentioned the use of CFD to quantify hemodynamics in patients with SPCs, and 25 articles provided specific formulas for collateral flow. Conclusions: Using cardiac magnetic resonance velocity mapping is currently regarded as the best method for quantifying SPC burden. The incorporation of CFD analysis with flow data acquired with CMR may be useful in simulating the effects of SPC burden prior to any intervention as well as in predicting the effects of SPC occlusion on patient hemodynamics.