Patient-Specific Left Ventricular Flow Simulations From Transthoracic Echocardiography: Robustness Evaluation and Validation Against Ultrasound Doppler and Magnetic Resonance Imaging

• Published in: IEEE transactions on medical imaging Vol. 36; no. 11; pp. 2261 - 2275
• Main Authors: Larsson, David, Spuhler, Jeannette H., Petersson, Sven, Nordenfur, Tim, Colarieti-Tosti, Massimiliano, Hoffman, Johan, Winter, Reidar, Larsson, Matilda
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.11.2017; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Accuracy; Adult; Aged; Algorithms; Blood flow; CFD; Computational fluid dynamics; Computational modeling; Computer applications; Computer simulation; Doppler effect; Echocardiography; Echocardiography - methods; Echocardiography, Doppler, Color - methods; Error analysis; Evaluation; Fluid dynamics; Heart; Heart Ventricles - diagnostic imaging; Humans; Hydrodynamics; Image Processing, Computer-Assisted - methods; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine - methods; Mathematical models; Medical imaging; Medical Technology; Medicinsk teknologi; Middle Aged; modelling; NMR; Nuclear magnetic resonance; patient-specific; Patient-Specific Modeling; Reproducibility of Results; Resonance; Robustness; robustness evaluation; Systole; Three dimensional flow; Transthoracic echocardiography; TTE; Ultrasonic imaging; Ultrasound; validation; Validation studies; Valves; Ventricle; Ventricular Function, Left - physiology; Young Adult
• ISSN: 0278-0062; 1558-254X; 1558-254X
• DOI: 10.1109/TMI.2017.2718218

The combination of medical imaging with computational fluid dynamics (CFD) has enabled the study of 3-D blood flow on a patient-specific level. However, with models based on gated high-resolution data, the study of transient flows, and any model implementation into routine cardiac care, is challenging. This paper presents a novel pathway for patient-specific CFD modelling of the left ventricle (LV), using 4-D transthoracic echocardiography (TTE) as input modality. To evaluate the clinical usability, two sub-studies were performed. First, a robustness evaluation was performed, where repeated models with alternating input variables were generated for six subjects and changes in simulated output quantified. Second, a validation study was carried out, where the pathway accuracy was evaluated against pulsed-wave Doppler (100 subjects), and 2-D through-plane phase-contrast magnetic resonance imaging measurements over seven intraventricular planes (6 subjects). The robustness evaluation indicated a model deviation of <;12%, with highest regional and temporal deviations at apical segments and at peak systole, respectively. The validation study showed an error of <;11% (velocities <;10 cm/s) for all subjects, with no significant regional or temporal differences observed. With the patient-specific pathway shown to provide robust output with high accuracy, and with the pathway dependent only on 4-D TTE, the method has a high potential to be used within future clinical studies on 3-D intraventricular flow patterns. To this, future model developments in the form of e.g., anatomically accurate LV valves may further enhance the clinical value of the simulations.