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Chair for Computer Aided Medical Procedures & Augmented Reality
Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality

K. Ralovich, L. Itu, D. Vitanovski, P. Sharma, Razvan Ioan Ionasec, V. Mihalef, W. Krawtschuk, Yefeng Zheng, A. Everett, G. Pongiglione, B. Leonardi, R. Ringel, N. Navab, T. Heimann, D. Comaniciu
Non-invasive Hemodynamic Assessment, Treatment Outcome Prediction and Follow-up of Aortic Coarctation from MR Imaging
Medical Physics Journal (bib)

{\bf Purpose:} Coarctation of the aorta (CoA?) is a congenital heart disease characterized by an abnormal narrowing of the proximal descending aorta. Severity of this pathology is quantified by the blood pressure drop ($\triangle P$) across the stenotic coarctation lesion. In order to evaluate the physiological significance of the pre-operative coarctation and to assess the post-operative results, the hemodynamic analysis is routinely performed by measuring the blood pressure drop ($\triangle P$) across the coarctation site via invasive cardiac catheterization.\\ The focus of this work is to present an alternative, non-invasive measurement of blood pressure drop $\triangle P$ through the introduction of a fast, image-based workflow for personalized computational modeling of the CoA? hemodynamics. {\bf Methods:} We propose an end-to-end system comprised of shape and computational models, their personalization setup using MR imaging, and a fast, non-invasive method based on computational fluid dynamics (CFD) to estimate the pre- and post-operative hemodynamics for coarctation patients. A virtual treatment method is investigated to assess the predictive power of our approach. {\bf Results:} Automatic thoracic aorta segmentation was applied on a population of 212 3D MR volumes, with mean symmetric point-to-mesh error of $3.00\pm1.58~mm$ and average computation time of $8~s$. Through quantitative evaluation of 6 CoA? patients, good agreement between computed blood pressure drop and catheter measurements is shown: average differences are $\myResPRE~mmHg$ (pre-), $\myResPOST~mmHg$ (post-operative), and $\myResVS~mmHg$ (virtual stenting), respectively. {\bf Conclusions:} The complete workflow is realized in a fast, mostly-automated system that is integrable in the clinical setting. To the best of our knowledge, this is the first time that three different settings (pre-operative - severity assessment, post-stenting - follow-up and virtual stenting - treatment outcome prediction) of CoA? are investigated on multiple subjects. We believe that in future -- given wider clinical validation -- our non-invasive {\it in-silico} method could replace invasive pressure catheterization for CoA?.
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