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Middle cerebral artery pressure laterality in patients with symptomatic ICA stenosis
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.ORCID-id: 0000-0002-1315-7010
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.ORCID-id: 0000-0002-3423-2083
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.ORCID-id: 0000-0002-0934-4534
Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.ORCID-id: 0000-0001-6784-1945
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2021 (Engelska)Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 16, nr 1, artikel-id e0245337Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

An internal carotid artery (ICA) stenosis can potentially decrease the perfusion pressure to the brain. In this study, computational fluid dynamics (CFD) was used to study if there was a hemispheric pressure laterality between the contra- and ipsilateral middle cerebral artery (MCA) in patients with a symptomatic ICA stenosis. We further investigated if this MCA pressure laterality (ΔPMCA) was related to the hemispheric flow laterality (ΔQ) in the anterior circulation, i.e., ICA, proximal MCA and the proximal anterior cerebral artery (ACA). Twenty-eight patients (73±6 years, range 59–80 years, 21 men) with symptomatic ICA stenosis were included. Flow rates were measured using 4D flow MRI data (PC-VIPR) and vessel geometries were obtained from computed tomography angiography. The ΔPMCA was calculated from CFD, where patient-specific flow rates were applied at all input- and output boundaries. The ΔPMCA between the contra- and ipsilateral side was 6.4±8.3 mmHg (p<0.001) (median 3.9 mmHg, range -1.3 to 31.9 mmHg). There was a linear correlation between the ΔPMCA and ΔQICA (r = 0.85, p<0.001) and ΔQACA (r = 0.71, p<0.001), respectively. The correlation to ΔQMCA was weaker (r = 0.47, p = 0.011). In conclusion, the MCA pressure laterality obtained with CFD, is a promising physiological biomarker that can grade the hemodynamic disturbance in patients with a symptomatic ICA stenosis.

Ort, förlag, år, upplaga, sidor
Public Library of Science , 2021. Vol. 16, nr 1, artikel-id e0245337
Nationell ämneskategori
Medicinsk bildbehandling Neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-182247DOI: 10.1371/journal.pone.0245337ISI: 000630020100027PubMedID: 33417614Scopus ID: 2-s2.0-85099353130OAI: oai:DiVA.org:umu-182247DiVA, id: diva2:1544220
Forskningsfinansiär
Vetenskapsrådet, 2015–05616Vetenskapsrådet, 2017-04949Vetenskapsrådet, 2016-07213Hjärt-Lungfonden, 20140592Tillgänglig från: 2021-04-14 Skapad: 2021-04-14 Senast uppdaterad: 2023-09-05Bibliografiskt granskad
Ingår i avhandling
1. 4D flow MRI and modelling to assess cerebral arterial hemodynamics: method development and evaluation, with implementation in patients with symptomatic carotid stenosis
Öppna denna publikation i ny flik eller fönster >>4D flow MRI and modelling to assess cerebral arterial hemodynamics: method development and evaluation, with implementation in patients with symptomatic carotid stenosis
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Blood flow measurements are important for understanding the development of cerebrovascular diseases. With 4D flow magnetic resonance imaging (4D flow MRI), simultaneous velocity measurements are obtained in all cerebral arteries in a scan of about ten minutes. However, 4D flow MRI is a relatively new technique. For usefulness in both clinics and research, detailed knowledge is needed about its accuracy and precision for flow quantification. In patients with stroke or transient ischemic attack (TIA) from a symptomatic carotid stenosis, the stenosis may generate a difference in blood pressure and flow between the left and right cerebral hemispheres. Such a hemispheric pressure difference could be an early marker of to what extent a stenosis is affecting cerebral hemodynamics, which could be useful in the planning of carotid surgery. 

The overall aim of the thesis was to determine the accuracy of 4D flow MRI to measure cerebral arterial blood flow, and to develop and evaluate an approach combining 4D flow MRI and computational fluid dynamics (CFD) to characterize the cerebral arterial hemodynamics, with implementation in patients with symptomatic carotid stenosis. The thesis is based on four papers, investigating two cohorts.

The first cohort consisted of 35 elderly volunteers (mean age 79 years) and was studied in paper I-II. Blood flow rates were measured in nine cerebral arteries with 4D flow MRI and 2D phase-contrast MRI as reference. Three different flow quantification methods for 4D flow MRI were evaluated and optimized: one clustering approach and two threshold-based methods. The proposed new method, based on a locally adapted threshold, outperformed the previously suggested methods in flow rate quantification. For the clustering method, flow rates were systematically underestimated. 4D flow MRI was also evaluated to assess different arterial pulsatility measures, and a Windkessel model was used to estimate reference values for cerebrovascular resistance and cerebral arterial compliance in elderly.

The second cohort consisted of 28 stroke and TIA patients (mean age 73 years) with symptomatic carotid stenosis and was studied in paper III-IV. With 4D flow MRI and CFD, the preoperative hemispheric pressure laterality was quantified in the patients. The pressure laterality was compared to hemispheric flow lateralities. Estimating the hemispheric pressure laterality was a promising physiological biomarker for grading the cerebral arterial hemodynamic disturbances in patients with symptomatic carotid stenosis. A CFD model was also developed to predict carotid stump pressure, i.e., the important pressure measured in the clamped carotid artery during surgical removal of the stenosis. The predicted stump pressures were correlated with the pressures measured during surgery. Stump pressure prediction was promising and could be a potential tool in the preoperative planning in order to avoid hypoperfusion during surgery. 

In summary, post-processing methods were successfully developed and evaluated for accurate assessment of mean and pulsatile cerebral blood flow rates with 4D flow MRI. Thereby, this thesis provided knowledge about possibilities and limitations of how 4D flow MRI can be used with respect to cerebral arterial blood flow rate assessment. By contributing with models combining 4D flow MRI and CFD, specifically developed for analysis of pressure distributions in cerebral arteries, novel methods were proposed for assessing patients with symptomatic carotid stenosis in the planning of carotid surgery.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2021. s. 69
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2128
Nyckelord
4D flow MRI, carotid stenosis, cerebral blood flow, cerebral arterial compliance, cerebrovascular resistance, circleof Willis, computational fluid dynamics, magnetic resonance imaging, stroke, vascular disease
Nationell ämneskategori
Medicinsk bildbehandling Neurologi
Forskningsämne
neurologi
Identifikatorer
urn:nbn:se:umu:diva-182250 (URN)978-91-7855-509-3 (ISBN)978-91-7855-510-9 (ISBN)
Disputation
2021-05-12, Betula, Norrlands universitetssjukhus + Zoom, Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2021-04-21 Skapad: 2021-04-14 Senast uppdaterad: 2021-11-01Bibliografiskt granskad

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Holmgren, MadeleneStoverud, Karen-HeleneZarrinkoob, LalehWåhlin, AndersMalm, JanEklund, Anders

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Holmgren, MadeleneStoverud, Karen-HeleneZarrinkoob, LalehWåhlin, AndersMalm, JanEklund, Anders
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RadiofysikNeurovetenskaperAnestesiologi och intensivvårdUmeå centrum för funktionell hjärnavbildning (UFBI)
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