Analyzing Circle of Willis blood flow in ischemic stroke patients through 3D Stroke Arterial Flow Estimation

Abstract

Background

The objective of ischemic stroke (IS) treatment is to achieve revascularization in cerebral arteries to restore blood flow. However, there is no available method to extract arterial flow data from clinical CTA images. We developed 3D Stroke Arterial Flow Estimation (SAFE), which provides blood flow data throughout the Circle of Willis based on 3D CTA and allows comparison of arterial flow distribution in the brain.

Methods

We implemented a newly developed 3D vascular reconstruction algorithm for clinical stroke CTA images.

Based on the patient-specific vascular structure, SAFE calculates time-resolved blood flow information for the entire Circle of Willis and allows quantitative flow study of IS cases. Clinical IS cases are presented to demonstrate the feasibility. Four patients with CTA images and CT perfusion data were studied. To validate the SAFE analysis, correlation analysis comparing blood flow at the MCA, ICA, and BA was performed.

Results

Different blood flow patterns were found in individual IS patients. Altered flow patterns and high collateral flow rates were found near occlusions in all cases. Quantitative comparison of blood flow data showed that SAFE obtained flow data and CTP were significantly correlated and provide complementary information about cerebral blood flow for individual patients.

Conclusions

We present SAFE analysis for collecting detailed time-resolved cerebral arterial flow data in the entire Circle of Willis for IS. Further study with more cases may be important to test the clinical utilization of SAFE and helpful to the study of the underlying hemodynamics of stroke.

Keywords

Cerebral blood flow ischemic stroke CT angiography Circle of Willis computational flow analysis collateral blood flow

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References

Moore

David

Chase

. 3D models of blood flow in the cerebral vasculature. J Biomech 2006; 39: 1454–1463.

Nam

Scalzo

Leng

. Hemodynamic impact of systolic blood pressure and hematocrit calculated by computational fluid dynamics in patients with intracranial atherosclerosis. J Neuroimaging 2016; 26: 331–338.

Patti

Viñuela

Chien

. Distinct trends of pulsatility found at the necks of ruptured and unruptured aneurysms. J Neurointerv Surg 2014; 6: 103–107.

Mut

Wright

Ascoli

. Morphometric, geographic, and territorial characterization of brain arterial trees. Int J Numer Method Biomed Eng 2014; 30: 755–766.

Yang X, Chen KTT and Chien A. Geodesic active contours with adaptive configuration for cerebral vessel and aneurysm segmentation. IEEE Pattern Recognition ICPR. 2014. DOI: 10.1109/ICPR.2014.553.

Chien

Sayre

Viñuela

. Comparative morphological analysis of the geometry of ruptured and unruptured aneurysms. Neurosurgery 2011; 69: 349–356.

Chien

Tateshima

Castro

. Patient-specific flow analysis of brain aneurysms at a single location: Comparison of hemodynamic characteristics in small aneurysms. Med Biol Eng Comput 2008; 46: 1113–1120.

Cebral

Castro

Burgess

. Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 2005; 26: 2550–2559.

von Kummer

Hacke

. Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery stroke. Stroke 1992; 23: 646–652.

10.

van Seeters

Biessels

Kappelle

. Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion. Neuroradiology 2016; 58: 969–977.