在稳定和搏动条件下模拟冠状动脉血流的自动省时框架

IF 4.9 2区 医学 Q1 COMPUTER SCIENCE, INTERDISCIPLINARY APPLICATIONS
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引用次数: 0

摘要

背景和目的有创分数血流储备(FFR)测量是诊断冠状动脉疾病(CAD)的金标准方法。FFR-CT 利用计算流体动力学(CFD)对 FFR 进行无创评估,在由计算机断层扫描(CT)重建的虚拟几何图形中模拟冠状动脉流动,但其计算过程成本高昂,且在定义患者特定边界条件(BCs)时存在不确定性。在这项工作中,我们研究了使用时间平均稳定边界条件(而不是脉冲边界条件)来减少计算时间,并采用了一种根据患者特定临床数据调整边界条件的自调整方法。对每条血管都进行了有创 FFR 测量。分割后,通过剪切出口并离散成四面体网格,为 CFD 模拟准备几何图形。稳定 BC 分两步定义:(i) 根据临床和图像数据推断静态 BCs;(ii) 根据静态条件计算充血 BCs。在模拟过程中反复调整流速,直到与患者的主动脉压力相匹配。脉动 BCs 是利用稳定 BCs 的收敛值定义的。CFD 模拟结束后,计算出病变特异性血流动力学指标,并在有手术指征和无手术指征的患者组之间进行比较。整个过程简单明了,每个步骤都是自动完成的。结果稳定和搏动 FFR-CT 产生了很强的相关性(r = 0.988,p <0.001),并与有创 FFR 相关(r = 0.797,p <0.001)。两种方法预测的压力场和 FFR-CT 场的每点差异分别低于 1 % 和 2 %。两种方法都表现出良好的诊断性能:准确率分别为 0.860 和 0.864,AUC 分别为 0.923 和 0.912。稳定 BCs CFD 所需的计算时间比脉冲式低约 30 倍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An automated and time-efficient framework for simulation of coronary blood flow under steady and pulsatile conditions

Background and objective

Invasive fractional flow reserve (FFR) measurement is the gold standard method for coronary artery disease (CAD) diagnosis. FFR-CT exploits computational fluid dynamics (CFD) for non-invasive evaluation of FFR, simulating coronary flow in virtual geometries reconstructed from computed tomography (CT), but suffers from cost-intensive computing process and uncertainties in the definition of patient specific boundary conditions (BCs). In this work, we investigated the use of time-averaged steady BCs, compared to pulsatile to reduce the computational time and deployed a self-adjusting method for the tuning of BCs to patient-specific clinical data.

Methods

133 coronary arteries were reconstructed form CT images of patients suffering from CAD. For each vessel, invasive FFR was measured. After segmentation, the geometries were prepared for CFD simulation by clipping the outlets and discretizing into tetrahedral mesh. Steady BCs were defined in two steps: (i) rest BCs were extrapolated from clinical and image-derived data; (ii) hyperemic BCs were computed from resting conditions. Flow rate was iteratively adjusted during the simulation, until patient's aortic pressure was matched. Pulsatile BCs were defined exploiting the convergence values of steady BCs. After CFD simulation, lesion-specific hemodynamic indexes were computed and compared between group of patients for which surgery was indicated and not. The whole pipeline was implemented as a straightforward process, in which each single step is performed automatically.

Results

Steady and pulsatile FFR-CT yielded a strong correlation (r = 0.988, p < 0.001) and correlated with invasive FFR (r = 0.797, p < 0.001). The per-point difference between the pressure and FFR-CT field predicted by the two methods was below 1 % and 2 %, respectively. Both approaches exhibited a good diagnostic performance: accuracy was 0.860 and 0.864, the AUC was 0.923 and 0.912, for steady and pulsatile case, respectively. The computational time required by steady BCs CFD was approximatively 30-folds lower than pulsatile case.

Conclusions

This work shows the feasibility of using steady BCs CFD for computing the FFR-CT in coronary arteries, as well as its computational and diagnostic performance within a fully automated pipeline.

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来源期刊
Computer methods and programs in biomedicine
Computer methods and programs in biomedicine 工程技术-工程:生物医学
CiteScore
12.30
自引率
6.60%
发文量
601
审稿时长
135 days
期刊介绍: To encourage the development of formal computing methods, and their application in biomedical research and medical practice, by illustration of fundamental principles in biomedical informatics research; to stimulate basic research into application software design; to report the state of research of biomedical information processing projects; to report new computer methodologies applied in biomedical areas; the eventual distribution of demonstrable software to avoid duplication of effort; to provide a forum for discussion and improvement of existing software; to optimize contact between national organizations and regional user groups by promoting an international exchange of information on formal methods, standards and software in biomedicine. Computer Methods and Programs in Biomedicine covers computing methodology and software systems derived from computing science for implementation in all aspects of biomedical research and medical practice. It is designed to serve: biochemists; biologists; geneticists; immunologists; neuroscientists; pharmacologists; toxicologists; clinicians; epidemiologists; psychiatrists; psychologists; cardiologists; chemists; (radio)physicists; computer scientists; programmers and systems analysts; biomedical, clinical, electrical and other engineers; teachers of medical informatics and users of educational software.
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