A magnetic resonance imaging-based computational analysis of cerebral hemodynamics in patients with carotid artery stenosis

Quantitative Imaging in Medicine and Surgery

article

Jonas Schollenberger¹  Drew J. Braet²  Luis Hernandez-Garcia¹  Nicholas H. Osborne²  C. Alberto Figueroa¹ 

[1] Department of Biomedical Engineering , University of Michigan;Department of Surgery , University of Michigan;Functional MRI Laboratory , University of Michigan

关键词: Computational fluid dynamics (CFD);    magnetic resonance imaging (MRI);    cerebral hemodynamics;    carotid artery stenosis (CAS);    collateral flow;   

DOI  :  10.21037/qims-22-565

学科分类：外科医学

来源: AME Publications

【 摘 要 】

Management of asymptomatic carotid artery stenosis (CAS) relies on measuring the percentage of stenosis. The aim of this study was to investigate the impact of CAS on cerebral hemodynamics using magnetic resonance imaging (MRI)-informed computational fluid dynamics (CFD) and to provide novel hemodynamic metrics that may improve the understanding of stroke risk. CFD analysis was performed in two patients with similar degrees of asymptomatic high-grade CAS. Three-dimensional anatomical-based computational models of cervical and cerebral blood flow were constructed and calibrated patient-specifically using phase-contrast MRI flow and arterial spin labeling perfusion data. Differences in cerebral hemodynamics were assessed in preoperative and postoperative models. Preoperatively, patient 1 demonstrated large flow and pressure reductions in the stenosed internal carotid artery, while patient 2 demonstrated only minor reductions. Patient 1 exhibited a large amount of flow compensation between hemispheres (80.31%), whereas patient 2 exhibited only a small amount of collateral flow (20.05%). There were significant differences in the mean pressure gradient over the stenosis between patients preoperatively (26.3 vs. 1.8 mmHg). Carotid endarterectomy resulted in only minor hemodynamic changes in patient 2. MRI-informed CFD analysis of two patients with similar clinical classifications of stenosis revealed significant differences in hemodynamics which were not apparent from anatomical assessment alone. Moreover, revascularization of CAS might not always result in hemodynamic improvements. Further studies are needed to investigate the clinical impact of hemodynamic differences and how they pertain to stroke risk and clinical management.

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