MRI-based computational fluid dynamics for diagnosis and treatment prediction: clinical validation study in patients with coarctation of aorta.
OBJECTIVE
To reduce the need for diagnostic catheterization and optimize treatment in a variety of congenital heart diseases, magnetic resonance imaging (MRI)-based computational fluid dynamics (CFD) is proposed. However, data about the accuracy of CFD in a clinical context are still sparse. To fill this gap, this study compares MRI-based CFD to catheterization in the coarctation of aorta (CoA) setting.


METHODS
Thirteen patients with CoA were investigated by routine MRI prior to catheterization. 3D whole-heart MRI was used to reconstruct geometries and 4D flow-sensitive phase-contrast MRI was used to acquire flows. Peak systolic flows were simulated using the program FLUENT.


RESULTS
Peak systolic pressure drops in CoA measured by catheterization and CFD correlated significantly for both pre- and posttreatment measurements (pre: r = 0.98, p = 0.00; post: r = 0.87, p = 0.00). The pretreatment bias was -0.5 ± 3.33 mmHg (95% confidence interval -2.55 to 1.47 mmHg). CFD predicted a reduction of the peak systolic pressure drop after treatment that ranged from 17.6 ± 5.56 mmHg to 6.7 ± 5.58 mmHg. The posttreatment bias was 3.0 ± 2.91 mmHg (95% CI -1.74 to 5.43 mmHg).


CONCLUSIONS
Peak systolic pressure drops can be reliably calculated using MRI-based CFD in a clinical setting. Therefore, CFD might be an attractive noninvasive alternative to diagnostic catheterization.
Biofluid Mechanics Laboratory, Charité-Universitätsmedizin, Berlin, Germany; Non-Invasive Cardiac Imaging in Congenital Heart Disease Unit, Charité-Universitätsmedizin, Berlin, and German Heart Institute, Berlin, Germany.
Leonid
L
Goubergrits
Eugenie
E
Riesenkampff
Pavlo
P
Yevtushenko
Jens
J
Schaller
Ulrich
U
Kertzscher
Anja
A
Hennemuth
Felix
F
Berger
Stephan
S
Schubert
Titus
T
Kuehne
D000293:Adolescent; D000328:Adult; D001017:Aortic Coarctation / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D055424:Cardiac-Gated Imaging Techniques; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D055414:Myocardial Perfusion Imaging / Q000379:methods; D015203:Reproducibility of Results; D012212:Rheology / Q000379:methods; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
aortic coarctation; catheterization; computational fluid dynamics; magnetic resonance imaging; pressure drop