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New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI

General Thoracic and Cardiovascular Surgery volume 65, pages 611–621 (2017)Cite this article

Abstract

Blood flow imaging is a novel technology in cardiovascular medicine and surgery. Today, two types of blood flow imaging tools are available: measurement-based flow visualization including 4D flow MRI (or 3D cine phase-contrast magnetic resonance imaging), or echocardiography flow visualization software, and computer flow simulation modeling based on computational fluid dynamics (CFD). MRI and echocardiography flow visualization provide measured blood flow but have limitations in temporal and spatial resolution, whereas CFD flow calculates the flow according to assumptions instead of flow measurement, and it has sufficiently fine resolution up to the computer memory limit, and it enables even virtual surgery when combined with computer graphics. Blood flow imaging provides profound insight into the pathophysiology of cardiovascular diseases, because it quantifies and visualizes mechanical stress on the vessel walls or heart ventricle. Wall shear stress (WSS) is a stress on the endothelial wall caused by the near wall blood flow, and it is thought to be a predictor of atherosclerosis progression in coronary or aortic diseases. Flow energy loss (EL) is the loss of blood flow energy caused by viscous friction of turbulent diseased flow, and it is expected to be a predictor of ventricular workload on various heart diseases including heart valve disease, cardiomyopathy, and congenital heart diseases. Blood flow imaging can provide useful information for developing predictive medicine in cardiovascular diseases, and may lead to breakthroughs in cardiovascular surgery, especially in the decision-making process.

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Abbreviations

CFD:

Computational fluid dynamics

CT:

Computed tomography

DCM:

Dilated cardiomyopathy

EL:

Energy loss

FFR:

Frictional flow reserve

LV:

Left ventricle

MRI:

Magnetic resonance imaging

OSI:

Oscillatory shear index

PC MRI:

Phase-contrast magnetic resonance imaging

SSFP:

Steady-state free procession

VFM:

Vector flow mapping

WSS:

Wall shear stress

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Affiliations

  1. Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan

    Keiichi Itatani, Satoshi Numata, Sachiko Yamazaki, Kazuki Morimoto, Rina Makino, Hiroko Morichi & Hitoshi Yaku

  2. Cardio Flow Design Inc., Tokyo, Japan

    Shohei Miyazaki, Tokoki Furusawa & Teruyasu Nishino

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  1. Keiichi Itatani
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Keiichi Itatani is an endowed chair of Kyoto Prefectural University of Medicine, financially supported by Medtronic Japan. Keiichi Itatani also has a stock option of Cardio Flow Design Inc. Keiichi Itatani has a KAKEN grant for young researcher A. Keiichi Itatani is a director of Hokkaido Cardiovascular Hospital. Other authors: Shohei Miyazaki, Tokoki Furusawa, Satoshi Numata, Sachiko Yamazaki, Kazuki Morimoto, Rina Makino, Hiroko Morichi, Teruyasu Nishino, and Hitoshi Yaku have no conflict of interest exists.

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Itatani, K., Miyazaki, S., Furusawa, T. et al. New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI. Gen Thorac Cardiovasc Surg 65, 611–621 (2017). https://doi.org/10.1007/s11748-017-0834-5

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Keywords

  • Blood flow imaging
  • Flow simulation
  • 4D flow MRI
  • Computational fluid dynamics
  • Mechanical stress