基于4D血流成像技术对主动脉瓣二瓣化畸形患者体内异常壁面剪应力进行更精确量化:基准测试及实际数据应用
Towards the improved quantification of in vivo abnormal wall shear stresses in BAV-affected patients from 4D-flow imaging: Benchmarking and application to real data.
作者信息
Piatti F, Pirola S, Bissell M, Nesteruk I, Sturla F, Della Corte A, Redaelli A, Votta E
机构信息
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.
Department of Chemical Engineering, Imperial College, London, United Kingdom.
出版信息
J Biomech. 2017 Jan 4;50:93-101. doi: 10.1016/j.jbiomech.2016.11.044. Epub 2016 Nov 11.
Bicuspid aortic valve (BAV), i.e. the fusion of two aortic valve cusps, is the most frequent congenital cardiac malformation. Its progression is often characterized by accelerated leaflet calcification and aortic wall dilation. These processes are likely enhanced by altered biomechanical stimuli, including fluid-dynamic wall shear stresses (WSS) acting on both the aortic wall and the aortic valve. Several studies have proposed the exploitation of 4D-flow magnetic resonance imaging sequences to characterize abnormal in vivo WSS in BAV-affected patients, to support prognosis and timing of intervention. However, current methods fail to quantify WSS peak values. On this basis, we developed two new methods for the improved quantification of in vivo WSS acting on the aortic wall based on 4D-flow data. We tested both methods separately and in combination on synthetic datasets obtained by two computational fluid-dynamics (CFD) models of the aorta with healthy and bicuspid aortic valve. Tests highlighted the need for data spatial resolution at least comparable to current clinical guidelines, the low sensitivity of the methods to data noise, and their capability, when used jointly, to compute more realistic peak WSS values as compared to state-of-the-art methods. The integrated application of the two methods on the real 4D-flow data from a preliminary cohort of three healthy volunteers and three BAV-affected patients confirmed these indications. In particular, quantified WSS peak values were one order of magnitude higher than those reported in previous 4D-flow studies, and much closer to those computed by highly time- and space-resolved CFD simulations.
二叶式主动脉瓣(BAV),即两个主动脉瓣叶融合,是最常见的先天性心脏畸形。其进展通常以瓣叶钙化加速和主动脉壁扩张为特征。这些过程可能因生物力学刺激改变而加剧,包括作用于主动脉壁和主动脉瓣的流体动力壁面剪应力(WSS)。多项研究提出利用四维流磁共振成像序列来表征BAV患者体内异常的WSS,以辅助预后评估和干预时机的选择。然而,目前的方法无法量化WSS峰值。在此基础上,我们基于四维流数据开发了两种新方法,用于改进对作用于主动脉壁的体内WSS的量化。我们分别以及联合测试了这两种方法,测试对象为通过具有健康主动脉瓣和二叶式主动脉瓣的两种主动脉计算流体动力学(CFD)模型获得的合成数据集。测试结果表明,数据空间分辨率至少需要与当前临床指南相当,这些方法对数据噪声的敏感性较低,并且与现有方法相比,联合使用时它们能够计算出更符合实际的WSS峰值。在来自三名健康志愿者和三名BAV患者的初步队列的真实四维流数据上对这两种方法进行综合应用,证实了这些结论。特别是,量化的WSS峰值比先前四维流研究报告的值高一个数量级,并且更接近通过高时间和空间分辨率的CFD模拟计算出的值。