Hemodynamics In Intracranial Aneurysms Research Articles

On flow fluctuations in ruptured and unruptured intracranial aneurysms: resolved numerical study

Flow fluctuations have emerged as a promising hemodynamic metric for understanding of hemodynamics in intracranial aneurysms. Several investigations have reported flow instabilities using numerical tools. In this study, the occurrence of flow fluctuations is investigated using either Newtonian or non-Newtonian fluid models in five patient-specific intracranial aneurysms using high-resolution lattice Boltzmann simulation methods. Flow instabilities are quantified by computing power spectral density, proper orthogonal decomposition, and fluctuating kinetic energy of velocity fluctuations. Our simulations reveal substantial flow instabilities in two of the ruptured aneurysms, where the pulsatile inflow through the neck leads to hydrodynamic instability, particularly around the rupture position, throughout the entire cardiac cycle. In other monitoring points, the flow instability is primarily observed during the deceleration phase; typically, the fluctuations begin just after peak systole, gradually decay, and the flow returns to its original, laminar pulsatile state during diastole. Additionally, we assess the rheological impact on flow dynamics. The disparity between Newtonian and non-Newtonian outcomes remains minimal in unruptured aneurysms, with less than a 5% difference in key metrics. However, in ruptured cases, adopting a non-Newtonian model yields a substantial increase in the fluctuations within the aneurysm sac, with up to a 30% higher fluctuating kinetic energy compared to the Newtonian model. The study highlights the importance of using appropriate high-resolution simulations and non-Newtonian models to capture flow fluctuation characteristics that may be critical for assessing aneurysm rupture risk.

Endovascular Treatment of Intracranial Aneurysm: The Importance of the Rheological Model in Blood Flow Simulations.

Hemodynamics in intracranial aneurysm strongly depends on the non-Newtonian blood behavior due to the large number of suspended cells and the ability of red blood cells to deform and aggregate. However, most numerical investigations on intracranial hemodynamics adopt the Newtonian hypothesis to model blood flow and predict aneurysm occlusion. The aim of this study was to analyze the effect of the blood rheological model on the hemodynamics of intracranial aneurysms in the presence or absence of endovascular treatment. A numerical investigation was performed under pulsatile flow conditions in a patient-specific aneurysm with and without the insertion of an appropriately reconstructed flow diverter stent (FDS). The numerical simulations were performed using Newtonian and non-Newtonian assumptions for blood rheology. In all cases, FDS placement reduced the intra-aneurysmal velocity and increased the relative residence time (RRT) on the aneurysmal wall, indicating progressive thrombus formation and aneurysm occlusion. However, the Newtonian model largely overestimated RRT values and consequent aneurysm healing with respect to the non-Newtonian models. Due to the non-Newtonian blood properties and the large discrepancy between Newtonian and non-Newtonian simulations, the Newtonian hypothesis should not be used in the study of the hemodynamics of intracranial aneurysm, especially in the presence of endovascular treatment.

Rupture point is associated with divergent hemodynamics in intracranial aneurysms.

Understanding the risk factors leading to intracranial aneurysm (IA) rupture have still not been fully clarified. They are vital for proper medical guidance of patients harboring unruptured IAs. Clarifying the hemodynamics associated with the point of rupture could help could provide useful information about some of the risk factors. Thus far, few studies have studied this issue with often diverging conclusions. We identified a point of rupture in patients operated for an IAs during surgery, using a combination of preoperative computed tomography (CT) and computed tomography angiography (CTA). Hemodynamic parameters were calculated both for the aneurysm sac as a whole and the point of rupture. In two cases, the results of CFD were compared with those of the experiment using particle image velocimetry (PIV). We were able to identify 6 aneurysms with a well-demarcated point of rupture. In four aneurysms, the rupture point was near the vortex with low wall shear stress (WSS) and high oscillatory shear index (OSI). In one case, the rupture point was in the flow jet with high WSS. In the last case, the rupture point was in the significant bleb and no specific hemodynamic parameters were found. The CFD results were verified in the PIV part of the study. Our study shows that different hemodynamic scenarios are associated with the site of IA rupture. The numerical simulations were confirmed by laboratory models. This study further supports the hypothesis that various pathological pathways may lead to aneurysm wall damage resulting in its rupture.

Using DFT on ultrasound measurements to determine patient-specific blood flow boundary conditions for computational hemodynamics of intracranial aneurysms

Boundary conditions (BCs) is one pivotal factor influencing the accuracy of hemodynamic predictions on intracranial aneurysms (IAs) using computational fluid dynamics (CFD) modeling. Unfortunately, a standard procedure to secure accurate BCs for hemodynamic modeling does not exist. To bridge such a knowledge gap, two representative patient-specific IA models (Case-I and Case-II) were reconstructed and their blood flow velocity waveforms in the internal carotid artery (ICA) were measured by ultrasonic techniques and modeled by discrete Fourier transform (DFT). Then, numerical investigations were conducted to explore the appropriate number of samples (N) for DFT modeling to secure the accurate BC by comparing a series of hemodynamic parameters using in-vitro validated CFD modeling. Subsequently, a comprehensive comparison in hemodynamic characteristics under patient-specific BCs and a generalized BC based on a one-dimensional (1D) model was conducted to reinforce the understanding that a patient-specific BC is pivotal for accurate hemodynamic risk evaluations on IA pathophysiology. In addition, the influence of the variance of heart rate/cardiac pulsatile period on hemodynamic characteristics in IA models was studied preliminarily. The results showed that N ≥ 16 for DFT model is a decent choice to secure the proper BC profile to calculate time-averaged hemodynamic parameters, while more data points such as N ≥ 36 can ensure the accuracy of instantaneous hemodynamic predictions. In addition, results revealed the generalized BC could overestimate or underestimate the hemodynamic risks on IAs significantly; thus, patient-specific BCs are highly recommended for hemodynamic modeling for IA risk evaluation. Furthermore, this study discovered the variance of heart rate has rare influences on hemodynamic characteristics in both instantaneous and time-averaged parameters under the assumption of an identical blood flow rate.

Fractals and Chaos in the Hemodynamics of Intracranial Aneurysms.

Computing the emerging flow in blood vessel sections by means of computational fluid dynamics is an often applied practice in hemodynamics research. One particular area for such investigations is related to the cerebral aneurysms, since their formation, pathogenesis, and the risk of a potential rupture may be flow-related. We present a study on the behavior of small advected particles in cerebral vessel sections in the presence of aneurysmal malformations. These malformations cause strong flow disturbances driving the system toward chaotic behavior. Within these flows, the particle trajectories can form a fractal structure, the properties of which are measurable by quantitative techniques. The measurable quantities are well established chaotic properties, such as the Lyapunov exponent, escape rate, and information dimension. Based on these findings, we propose that chaotic flow within blood vessels in the vicinity of the aneurysm might be relevant for the pathogenesis and development of this malformation.

Evaluating the Impact of Domain Boundaries on Hemodynamics in Intracranial Aneurysms within the Circle of Willis

Hemodynamic simulations are increasingly used to study vascular diseases such as Intracranial Aneurysms (IA) and to further develop treatment options. However, due to limited data, certain aspects must rely on heuristics, especially at the simulation’s distal ends. In the literature, Murray’s Law is often used to model the outflow split based on vessel cross-section area; however, this poses challenges for the communicating arteries in the Circle of Willis (CoW). In this study, we contribute by assessing the impact of Murray’s Law in patient-specific geometries featuring IA at the posterior communication. We simulate different domain extensions representing common modelling choices and establish Full CoW simulations as a baseline to evaluate the effect of these modelling assumptions on hemodynamic indicators, focusing on IA growth and rupture-related factors such as the Wall Shear Stress (WSS) and Oscillatory Shear Index (OSI). Our findings reveal qualitative alterations in hemodynamics when not modeling posterior communication. Comparisons between computing the anterior circulation and computing the whole Circle of Willis reveal that quantitative changes in WSS may reach up to 80%, highlighting the significance of modelling choices in assessing IA risks and treatment strategies.

Global tendencies and frontier topics in hemodynamics research of intracranial aneurysms: a bibliometric analysis from 1999 to 2022

Background: Hemodynamics plays a crucial role in the initiation, enlargement, and rupture of intracranial aneurysms (IAs). This bibliometric analysis aimed to map the knowledge network of IA hemodynamic research.Methods: Studies on hemodynamics in IAs published from 1999 to 2022 were retrieved from the Web of Science Core Collection (WoSCC). The contributions of countries, institutions, authors, and journals were identified using VOSviewer, Scimago Graphica, and Microsoft Excel. Tendencies, frontier topics, and knowledge networks were analyzed and visualized using VOSviewer and CiteSpace.Results: We identified 2,319 publications on hemodynamics in IAs. The annual number of publications exhibited an overall increasing trend. Among these, the United States, Japan, and China were the three major contributing countries. Capital Medical University, State University of New York (SUNY) Buffalo University, and George Mason University were the three most productive institutions. Meng H ranked first among authors regarding the number of articles and citations, while Cebral JR was first among co-cited authors. The American Journal of Neuroradiology was the top journal in terms of the number of publications, citations, and co-citations. In addition, the research topics can be divided into three clusters: hemodynamics itself, the relationship of hemodynamics with IA rupture, and the relationship of hemodynamics with IA treatment. The frontier directions included flow diverters, complications, morphology, prediction, recanalization, and four-dimensional flow magnetic resonance imaging (4D flow MRI).Conclusion: This study drew a knowledge map of the top countries, institutions, authors, publications, and journals on IA hemodynamics over the past 2 decades. The current and future hotspots of IA hemodynamics mainly include hemodynamics itself (4D flow MRI), its relationship with IA rupture (morphology and prediction), and its relationship with IA treatment (flow diverters, complications, and recanalization).

Is Accurate Lumen Segmentation More Important than Outlet Boundary Condition in Image-Based Blood Flow Simulations for Intracranial Aneurysms?

PurposeImage-based blood flow simulations are increasingly used to investigate the hemodynamics in intracranial aneurysms (IAs). However, a strong variability in segmentation approaches as well as the absence of individualized boundary conditions (BCs) influence the quality of these simulation results leading to imprecision and decreased reliability. This study aims to analyze these influences on relevant hemodynamic parameters within IAs.MethodsAs a follow-up study of an international multiple aneurysms challenge, the segmentation results of five IAs differing in size and location were investigated. Specifically, five possible outlet BCs were considered in each of the IAs. These are comprised of the zero-pressure condition (BC1), a flow distribution based on Murray’s law with the exponents n = 2 (BC2) and n = 3 (BC3) as well as two advanced flow-splitting models considering the real vessels by including circular cross sections (BC4) or anatomical cross sections (BC5), respectively. In total, 120 time-dependent blood flow simulations were analyzed qualitatively and quantitatively, focusing on five representative intra-aneurysmal flow and five shear parameters such as vorticity and wall shear stress.ResultsThe outlet BC variation revealed substantial differences. Higher shear stresses (up to Δ9.69 Pa), intrasaccular velocities (up to Δ0.15 m/s) and vorticities (up to Δ629.22 1/s) were detected when advanced flow-splitting was applied compared to the widely used zero-pressure BC. The tendency of outlets BCs to over- or underestimate hemodynamic parameters is consistent across different segmentations of a single aneurysm model. Segmentation-induced variability reaches Δ19.58 Pa, Δ0.42 m/s and Δ957.27 1/s, respectively. Excluding low fidelity segmentations, however, (a) reduces the deviation drastically (>43%) and (b) leads to a lower impact of the outlet BC on hemodynamic predictions.ConclusionWith a more realistic lumen segmentation, the influence of the BC on the resulting hemodynamics is decreased. A realistic lumen segmentation can be ensured, e.g., by using high-resolved 2D images. Furthermore, the selection of an advanced outflow-splitting model is advised and the use of a zero-pressure BC and BC based on Murray’s law with exponent n = 3 should be avoided.

Fluid–structure interaction simulation for studying hemodynamics and rupture risk of patient-specific intracranial aneurysms

Purpose The role of regional hemodynamics in intracranial aneurysms (IAs) hemodynamics and rupture risk has been widely discussed based on numerical models over the past decades. The aim of this paper is to investigate hemodynamics and rupture risk with a complicated IA model. Methods Fluid-structure interaction (FSI) simulations were performed to quantify the hemodynamic characteristics of the established IA models. Hemodynamic parameters, including wall shear stress (WSS), flow velocity, and flow pattern, were calculated and analyzed. Results In this paper, the risk assessment of intracranial aneurysms focuses on the mechanical properties of blood flow and blood vessel walls. Vortex flow and concentrated impact field during blood flow play a decisive role in the rupture and development of aneurysms. The uneven distribution of wall shear stress on the vessel wall has a great influence on growth and rupture. By observing the simulation results of rigid walls, risks can be predicted efficiently and accurately. Conclusions This paper focuses on the relationship between hemodynamics and ruptures risk with a double intracranial aneurysms disease mode and provides a new perspective on the treatment of intracranial aneurysms.

High-fidelity fluid structure interaction simulations of turbulent-like aneurysm flows reveals high-frequency narrowband wall vibrations: A stimulus of mechanobiological relevance?

Recent high-fidelity/resolution computational fluid dynamics simulations of intracranial aneurysm hemodynamics have revealed turbulent-like flows. We hypothesized that the associated high-frequency pressure fluctuations could promote aneurysm wall vibrations. We performed fully coupled high-fidelity transient fluid structure interaction simulations between the blood flow and compliant aneurysm sac wall taking 5,000 time steps per second using a 3D patient-specific model previously shown to harbour turbulent-like flow. Our results show that the flow velocity contained fluctuations with a smooth and continuously decaying energy up to ∼160Hz, and fluctuating pressures with characteristic frequency peaks at approximately 30, 130 and 210Hz. There was a strong two-way coupling between the pressure and the wall deformation, for which the frequency spectrum showed similar characteristics, but with a narrow band peak at ∼120Hz with large regional differences in amplitude up to 80μm. The physics of the flow is broadly consistent with clinical reports of turbulent-like flows, while the physics of the wall is consistent with reports of spectral peaks in aneurysm patients. As many aneurysms are known to harbour turbulent-like flows, wall vibrations could be a widespread phenomenon. Finally, since aneurysms are vascular pathologies by definition and many/most aneurysms do not have endothelial cells but still display a focal remodeling, we hypothesize that vibrations and stresses within the wall itself might play a role in the mechanobiological processes of vessel wall pathology.

Impact of patient-specific inflow boundary conditions on intracranial aneurysm hemodynamics

Abstract For hemodynamic simulations of intracranial aneurysms boundary conditions (BC) are required. In most cases, these are not patient-specific and thus do not reflect the real flow conditions in the patient. This study investigates the influence of patient-specific inflow BC on intra-aneurysmal hemodynamics. The focus lies on gender and age variations of the patients. To asses the impact, four different inflow curves representing the velocity profile of the inflow over one cardiac cycle is modeled. These four inflow BC are varied in the simulations of each aneurysm from selected subgroups. From the results of the simulations, the hemodynamic parameters are determined for each inflow BC and the percent differences between inflow BC are determined. The results show that the hemodynamic parameters are not robust to varying inflow BC. It can be seen that age has more influence on the hemodynamic parameters than gender. This study demonstrates the dependence of valid hemodynamic parameters on realistic inflow BC. Thus, if available, patient-specific inflow curves are recommended.

Non-Newtonian Blood Modeling in Intracranial Aneurysm Hemodynamics: Impact on the Wall Shear Stress and Oscillatory Shear Index Metrics for Ruptured and Unruptured Cases.

When simulating blood flow in intracranial aneurysms (IAs), the Newtonian model seems to be ubiquitous. However, analyzing the results from the few studies on this subject, the doubt remains on whether it is necessary to use non-Newtonian models in computational fluid dynamics (CFD) simulations of cerebral vascular flows. The objective of this study is to investigate whether different rheology models would influence the hemodynamic parameters related to the wall shear stress (WSS) for ruptured and unruptured IA cases, especially because ruptured aneurysms normally have morphological features, such as lobular regions and blebs, that could trigger non-Newtonian phenomena in the blood flow due to low shear rates. Using CFD in an open-source framework, we simulated four ruptured and four unruptured patient-specific aneurysms to assess the influence of the blood modeling on the main hemodynamic variables associated with aneurysm formation, growth, and rupture. Results for WSS and oscillatory shear index (OSI) and their metrics were obtained using Casson and Carreau-Yasuda non-Newtonian models and were compared with those obtained using the Newtonian model. We found that all differences between non-Newtonian and the Newtonian models were consistent among all cases irrespective of their rupture status. We further found that the WSS at peak systole is overestimated by more than 50% by using the non-Newtonian models, but its metrics based on time and surface averaged values are less affected-the maximum relative difference among the cases is 7% for the Casson model. On the other hand, the surface-averaged OSI is underestimated by more than 30% by the non-Newtonian models. These results suggest that it is recommended to investigate different blood rheology models in IAs simulations when specific parameters to characterize the flow are needed, such as peak-systole WSS and OSI.

Inflow Hemodynamics of Intracranial Aneurysms: A Comparison of Computational Fluid Dynamics and 4D Flow Magnetic Resonance Imaging

PurposeAlthough the inflow hemodynamics of cerebral aneurysms are key factors in their rupture and recurrence after endovascular treatments, the most available method for inflow hemodynamics evaluation remains unestablished. We compared the efficacy of inflow hemodynamics evaluation using computational fluid dynamics (CFD) analysis and that using four-dimensional (4D) flow magnetic resonance imaging (MRI). MethodsIn 23 unruptured cerebral aneurysms, the inflow hemodynamics was evaluated using both CFD and 4D flow MRI. The evaluated parameters included visually classified inflow jet patterns, the inflow rate ratio (the ratio of the inflow rate at the aneurysmal orifice to the flow rate in the proximal parent artery), and the velocity ratio (the ratio of the inflow velocity to the velocity in the proximal parent artery). The Shapiro-Wilk test was used to assess the normality of variable data, and logarithmic transformation was performed for variables with non-normal distributions. Data analysis was performed using Pearson correlation analyses and the chi-square test. ResultsThere was a significant correlation between inflow jet patterns evaluated by CFD and 4D flow MRI (p = 0.008). Moreover, there was a strong correlation between the inflow rate ratios evaluated by CFD and 4D flow MRI (r = 0.801; p <0.001). Furthermore, there was a moderate correlation between the velocity ratios measured by CFD and 4D flow MRI (r = 0.559; p = 0.008). ConclusionInflow hemodynamics evaluated by CFD analysis and 4D flow MRI showed good correlations in inflow jet pattern, inflow rate ratio, and velocity ratio.

Unsteady Hemodynamics in Intracranial Aneurysms With Varying Dome Orientations

Abstract Fluid loading within an intracranial aneurysm is difficult to measure but can be related to the shape of the flow passage. The outcome of excessive loading is a fatal hemorrhage, making it necessary for early diagnosis. However, arterial diseases are asymptomatic and clinical assessment is a challenge. A realistic approach to examining the severity of wall loading is from the morphology of the aneurysm itself. Accordingly, this study compares pulsatile flow (Reynolds number Re = 426, Womersley number Wo = 4.7) in three different intracranial aneurysm geometries. Specifically, the spatio-temporal movement of vortices is followed in high aspect ratio aneurysm models whose domes are inclined along with angles of 0, 45, and 90 deg relative to the plane of the parent artery. The study is based on finite volume simulation of unsteady three-dimensional flow while a limited set of particle image velocimetry experiments have been carried out. Within a pulsatile cycle, an increase in inclination (0–90 deg) is seen to shift the point of impingement from the distal end toward the aneurysmal apex. This change in flow pattern strengthens helicity, drifts vortex cores, enhances spatial displacement of the vortex, and generates skewed Dean's vortices on transverse planes. Patches of wall shear stress and wall pressure shift spatially from the distal end in models of low inclination (0–45 deg) and circumscribe the aneurysmal wall for an inclination angle of 90 deg. Accordingly, it is concluded that high angles of inclination increase rupture risks while lower inclinations are comparatively safe.

Associations between morphology and hemodynamics of intracranial aneurysms based on 4D flow and black-blood magnetic resonance imaging.

Previous studies have hypothesized that intracranial aneurysm (IA) morphology interacts with hemodynamic conditions. Magnetic resonance imaging (MRI) provides a single image modality solution for both morphological and hemodynamic measurements for IA. This study aimed to explore the interaction between the morphology and hemodynamics of IA using black-blood MRI (BB-MRI) and 4D flow MRI. A total of 97 patients with unruptured IA were recruited for this study. The IA size, size ratio (SR), and minimum wall thickness (mWT) were measured using BB-MRI. Velocity, blood flow, pulsatility index (PI), and wall shear stress (WSS) were measured with 4D flow MRI. The relationship between hemodynamic parameters and morphological indices was investigated by linear regression analysis and unpaired two-sample t-test. To determine the independent interaction, multiple linear regression analysis was further performed. The findings showed that mWT was negatively correlated with IA size (r=-0.665, P<0.001). Maximum blood flow in IA (FlowIA) was positively correlated with IA size (r=0.458, P<0.001). The average WSS (WSSavg) was negatively correlated with IA size (r=-0.650, P<0.001). The relationships remained the same after the multivariate analysis was adjusted for hemodynamic, morphologic, and demographic confounding factors. The WSSavg was positively correlated with mWT (r=0.528, P<0.001). In the unpaired two-sample t-test, mWT, WSSavg, and FlowIA were statistically significantly associated with the size and SR of IAs. There is potential for BB-MRI and 4D flow MRI to provide morphological and hemodynamic information regarding IA. Blood flow, WSS, and mWT may serve as non-invasive biomarkers for IA assessments, and may contribute to a more comprehensive understanding of the mechanism of IA.

The Impact of Inflow Angle on Aneurysm Hemodynamics: A Simulation Study Based on Patient-Specific Intracranial Aneurysm Models.

The inflow angle of intracranial aneurysms (IAs) can impact the hemodynamics of IAs, therefore it is likely to contribute to IA clinical rupture risk stratification. This study aimed to assess the effect of inflow angle on the hemodynamics of IAs, as well as its potential ability to predict IA rupture risk. A novel algorithm was developed to build a series of inflow angle models on patient-specific IA models, which were reconstructed from IA 3DRA image data of eleven clinical patients. Fully coupled fluid-structure interaction (FSI) simulations were performed to quantify hemodynamic characteristics of the established IA models with various inflow angles. Hemodynamic parameters including wall shear stress (WSS), flow velocity, flow pattern, inflow zone, impingement region, pressure, and energy loss (EL) were calculated and analyzed. It was demonstrated from the analysis that a rise in the IA inflow angle is associated with the following hemodynamic changes: more direct blood flowed into the aneurysm sac, higher velocity at the upside of the aneurysm, upregulated flow velocity and WSS in the aneurysm, more complicated flow patterns, extended inflow zone, the impingement region moving upward from the neck to the apex of the aneurysm, and higher WSS and larger flow velocity at the inflow zone of the IAs. Therefore, the proposed method may be helpful in exploring the hemodynamic variations of IAs with inflow angles. The findings could be conducive to hemodynamic studies on the association between IA inflow angle and its rupture risk.

Effects of wall compliance on multiharmonic pulsatile flow in idealized cerebral aneurysm models: comparative PIV experiments

The hemodynamics of intracranial aneurysm (IA) comprise complex phenomena that influence the IA’s growth and rupture risk. It has long been argued in in silico studies of IA hemodynamics that wall compliance could be neglected, because it does not alter the hemodynamic patterns. The purpose of this work is to investigate the effect of wall compliance on IA hemodynamic patterns and flow field variables. We conducted comparative in vitro laser PIV measurements on rigid silicone and elastic PVA-H models of side-wall IA. In the first study of its kind, the interaction between wall dynamics and IA hemodynamics is investigated experimentally at high spatio-temporal resolution. It is evidently shown that wall compliance affects the phase-shift, flow rate and pressure damping, velocity and vorticity fields inside the aneurysm in space and time. Near-wall velocity field, which affects vascular endothelial cells in reality, was found to have larger oscillations in the compliant model, leading to higher turbulent kinetic energy. Wall shear stress was also affected by wall compliance, with lower time average values but larger temporal variations. These differences emphasize the importance of modeling the compliance behavior of cerebral arteries in the study of aneurysms and their treatment.

Discrimination of intracranial aneurysm rupture status: patient-specific inflow boundary may not be a must-have condition in hemodynamic simulations.

Computational fluid dynamics (CFD) are important in evaluating the hemodynamics of intracranial aneurysm rupture, and the setting of inflow boundary conditions is critical. We evaluated intracranial aneurysm hemodynamics based on generalized versus patient-specific inflow boundary conditions to examine the effect of different hemodynamic results on the discrimination of intracranial aneurysm rupture status. We enrolled 148 patients with 156 intracranial aneurysms. For each included aneurysm, we performed CFD simulation once based on patient-specific and once based on generalized inflow boundary conditions. First, we compared the hemodynamics of intracranial aneurysms based on different inflow boundary conditions. Then, we divided the included aneurysms into a ruptured and unruptured group and compared the hemodynamics between the two groups under patient-specific and generalized inflow boundary conditions. For the hemodynamic parameters using specific inflow boundary conditions, more complex flow (p = 0.002), larger minimum WSS (p = 0.024), lower maximum low WSS area (LSA) (p = 0.038), and oscillatory shear index (p = 0.002) were found. Furthermore, we compared the hemodynamics between ruptured and unruptured groups based on different inflow boundary conditions. We found that the significant hemodynamic parameters associated with rupture status were the same, including the proportion of aneurysms with flow complex and unstable flow and the minimum and maximum of LSA (p = 0.011, p = 0.003, p = 0.001 and p = 0.004, respectively). Patient-specific and generalized inflow boundary conditions of aneurysmal hemodynamics resulted in significant differences. However, the significant parameters associated with rupture status were the same in both conditions, indicating that patient-specific inflow boundary conditions may not be necessary for predicting rupture risk.

In Vitro Assessment of Flow Variability in an Intracranial Aneurysm Model Using 4D Flow MRI and Tomographic PIV.

Aneurysm rupture has been suggested to be related to aneurysm geometry, morphology, and complex flow activity; therefore, understanding aneurysm-specific hemodynamics is crucial. 4D Flow MRI has beenshown to be a feasible tool for assessing hemodynamics in intracranial aneurysms with high spatial resolution. However, it requires averaging over multiple heartbeats and cannot account for cycle-to-cycle hemodynamics variations. This study aimed to assess cycle-to-cycle flow dynamics variations in a patient-specific intracranial aneurysm model using tomographic particle image velocimetry (tomo-PIV) at a high image rate under pulsatile flow conditions. Time-resolved and time-averaged velocity flow fields within the aneurysm sac and estimations of wall shear stress (WSS) were compared with those from 4D Flow MRI. A one-way ANOVA showed a significant difference between cardiac cycles (p value < 0.0001); however, differences were not significant after PIV temporal and spatial resolution was matched to that of MRI (p value 0.9727). This comparison showed the spatial resolution to be the main contributor to assess cycle-to-cycle variability. Furthermore, the comparison with 4D Flow MRI between velocity components, streamlines, and estimated WSS showed good qualitative and quantitative agreement. This study showed the feasibility of patient-specific in-vitro experiments using tomo-PIV to assess 4D Flow MRI with high repeatability in the measurements.

Inter-patient variations in flow boundary conditions at middle cerebral artery from 7T PC-MRI and influence on Computational Fluid Dynamics of intracranial aneurysms

BackgroundComputational fluid dynamics(CFD) of intracranial aneurysms requires flow boundary conditions(BCs) as inputs. Patient-specific BCs are usually unavailable and substituted by literature-derived generic BCs. Therefore, we investigated inter-patient BC variations and their influence on middle cerebral artery aneurysmal hemodynamics. MethodWe retrospectively collected CT angiography and 7-T Phase-Contrast(PC)-MRI data from eight middle-cerebral-artery bifurcation aneurysms to reconstruct the geometry and measure the arterial flowrates, respectively. The coefficient of variation(CoV) was calculated for the inlet flowrate and the pulsatility index(PI). The outflow split estimated by Murray's law was compared with PC-MRI measurements. For each aneurysm, we performed seven simulations: “baseline” using PC-MRI-derived BCs and the other six with changing BCs to explore the influence of BC variations on hemodynamics. ResultsFrom PC-MRI, the inlet flowrate was 1.94 ± 0.71 cm3/s(CoV = 36%) and PI was 0.37 ± 0.13(CoV = 34%). The outflow split estimated by Murray's law deviated by 15.3% compared to PC-MRI. Comparing to “baseline” models, ±36% variations in inlet flowrate caused −61% to +89% changes in time-averaged wall shear stress(WSS), −37% to +32% in normalized WSS(NWSS; by parent-artery), and −42% to +126% in oscillatory shear index(OSI). The ±34% variations in PI caused, −46% to +67% in OSI. Applying ±15% variations in outflow split led to inflow jet deflection and −41% to +52% changes in WSS, −41% to +47% in NWSS, and −44% to +144% in OSI. ConclusionInflow rate and outflow split have a drastic impact on hemodynamics of intracranial aneurysms. Inlet waveform has a negligible impact on WSS and NWSS but major impact on OSI. CFD-based models need to consider such sensitivity.